ANDREA JO GOETHALS (D.O.) – Surgery Physician, NPI 1104956895

ANDREA JO GOETHALS (D.O.) is a healthcare provider. based in Grand blanc, Michigan. specializing in GENERAL SURGERY. They hold the professional credentials D.O.. They hold a License No. 5101015223 (MI). The NPI Number for ANDREA JO GOETHALS (D.O.) is 1104956895

Main info

Female
24 Years Of Experience
Accepts Medicare Assignment
Name
ANDREA JO GOETHALS (D.O.)
NPI
1104956895
Phone
(810) 694-9700
Address
8235 HOLLY RD
Enumeration Date
6 March 2007
Last Update Date
29 April 2009

Doctor Profile

Medical School Name
MICHIGAN STATE UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE
Secondary Phone
8102323522
Graduation Year
2002 (24 years ago)
PAC ID
0244322659
Group Practice PAC ID
2062323033
Professional Enrollment ID
I20070815000251
Address ID
MI485021803FL420XXSTXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience52
Completeness75
Years active:19State licenses:1Digital endpointsOther names

1,444 GENERAL SURGERY in MI

Provider Addresses for ANDREA JO GOETHALS (D.O.)

  • 8235 HOLLY RD

    SUITE 1

    GRAND BLANC, MI 484392441

    Phone: (810) 694-9700

    Fax: (810) 694-9940

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 7 Open Payments records for all available years, with a total value of $481.

Total Amount is formed as General ($481) + Research ($0) + Ownership ($0) = $481.

Last reported payment date: 2024-08-27 • Largest payer in this snapshot: Zimmer Biomet Holdings, Inc. ($146).

Total Amount

$481

General + Research + Ownership

Payments

7

Total payment records

General Amount

$481

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-08-27

Latest reported date

View all Open Payments →|Open Payments Risk Radar →

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2007-08-15

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20070815000251IGeneral SurgeryMITBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99232Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes2116$0
99222Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes1616$0
99204New patient office or other outpatient visit, 45-59 minutes1111$0
View full utilization report →

Insurance plans in this area (ZIP 48439)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2062323033View full group profile
NameSpecialtyState
Certified Registered Nurse Anesthetist (Crna)MI
Certified Registered Nurse Anesthetist (Crna)MI
-MI
-MI
Family PracticeMI
Certified Registered Nurse Anesthetist (Crna)MI
Certified Registered Nurse Anesthetist (Crna)MI
Certified Registered Nurse Anesthetist (Crna)MI
-MI
Certified Registered Nurse Anesthetist (Crna)MI

Reviews

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Frequently asked questions

What number should I use to identify ANDREA JO GOETHALS (D.O.) for billing?
Administrative and clinical systems typically use NPI 1104956895 for ANDREA JO GOETHALS (D.O.).
Does the public listing show ANDREA JO GOETHALS (D.O.) as active?
ANDREA JO GOETHALS (D.O.)'s NPI record reflects an active status in NPPES.
Which specialty label fits ANDREA JO GOETHALS (D.O.)?
NPPES ties ANDREA JO GOETHALS (D.O.) to Surgery Physician in the taxonomy section. Clinical services aligned with this taxonomy classification.
Is ANDREA JO GOETHALS (D.O.) tied to Grand Blanc, Michigan?
If you are local to Grand Blanc, Michigan, ANDREA JO GOETHALS (D.O.) may be relevant to your search.
Can I export ANDREA JO GOETHALS (D.O.)'s record?
You can download the official NPPES record; we summarize key fields for readability.

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