DR. GLENN LEE GOODHART (M.D.) – Specialist, NPI 1568481356
Specialist
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for DR. GLENN LEE GOODHART (M.D.)
2142 N Cove Blvd
Toledo, OH 436063895
Phone: (419) 291-4000
Fax: (419) 479-6102
Type: Location
250 N Wickham Rd
Melbourne, FL 329358625
Phone: (321) 752-1200
Fax: (321) 752-1698
Type: Location
2675 N Decatur Rd
Suite 312
Decatur, GA 300336131
Phone: (404) 501-7316
Fax: (404) 501-7319
Type: Location
801 5th St
Sioux City, IA 511011326
Phone: (712) 279-2010
Fax: (712) 279-2034
Type: Location
1412 Milstead Ave NE
Conyers, GA 300123877
Phone: (770) 918-3000
Fax: (770) 918-3104
Type: Location
Corporate Boulevard, Lafayette, Lafayette Parish, Louisiana, 70502, United States
LAFAYETTE, LA 705083870
Phone: (800) 893-9698
Type: Mailing
27, Davenport Place, Hempstead, Nassau County, New York, 11710, United States
DAVENPORT, FL 338375906
Phone: (863) 422-4971
Fax: (863) 419-2264
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
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: 2018-09-04
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20120509000654 | I | Internal Medicine | GA | TBD |
| I20180904002094 | I | Internal Medicine | VA | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 43606)
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