JACK GOLDMAN (M.D.) – Internal Medicine Physician, NPI 1023065539
Internal Medicine Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
4,056 INTERNAL MEDICINE in WA
Provider Addresses for JACK GOLDMAN (M.D.)
30809 1st Ave S
Federal Way, WA 980034074
Phone: (253) 839-2030
Fax: (253) 839-1071
Type: Location
South Sound Surgery - John Conrad, MD, 101, 2nd Street Northeast, Downtown, Auburn, King County, Washington, 98071, United States
AUBURN, WA 980024902
Phone: (253) 833-3650
Type: Mailing
33634 7TH PL SW
FEDERAL WAY, WA 980235004
Phone: (253) 833-3650
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 127 Open Payments records for all available years, with a total value of $5,768.
Total Amount is formed as General ($5,768) + Research ($0) + Ownership ($0) = $5,768.
Last reported payment date: 2024-12-20 • Largest payer in this snapshot: AstraZeneca Pharmaceuticals LP ($833).
Total Amount
$5,768
General + Research + Ownership
Payments
127
Total payment records
General Amount
$5,768
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-20
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| AstraZeneca Pharmaceuticals LP | $833 |
| Kowa Pharmaceuticals America, Inc. | $653 |
| Novo Nordisk Inc | $644 |
| GlaxoSmithKline, LLC. | $365 |
| ABBVIE INC. | $345 |
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: 2011-01-06
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20110106000347 | I | Internal Medicine | WA | TBD |
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.
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
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 170 | 76 | $0 |
Insurance plans in this area (ZIP 98003)
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Provider's Procedures
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