Individual provider Active NPI

Hannah Leigh Goodrum, PA-C

  • Surgical Physician Assistant
  • Cary, NC
National Provider Identifier
1073246203
Registry record updated Mar 31, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
0010-12258 Issued in NC
Practice address
210 Ashville Ave
Cary, NC 27518-6676
Phone
(919) 350-9355
Fax
(919) 851-6757
NPI assigned
Jul 6, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 31, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgical Critical Care Physician 2086S0102X 0010-12258 NC
Physician Assistant 363A00000X 0010-12258 NC
Surgical Physician Assistant 363AS0400X 0010-12258 NC Primary

Addresses

Primary practice location

210 Ashville Ave
Cary, NC 27518-6676

Mailing address

3024 New Bern Ave
Raleigh, NC 27610-1247
Phone (919) 350-7331

Other practice location 1

3533 Southern Blvd Ste 2100
Kettering, OH 45429-1267
Phone (937) 395-8556

Other identifiers 1

IdentifierTypeStateIssuer
1073246203MedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY, NC, OH3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20221025000718 KY Practitioner - Physician Assistant 0749656296 Reassigns benefits to 1 organization
I20240801002592 NC Practitioner - Physician Assistant 0749656296 Reassigns benefits to 1 organization
I20260414002389 OH Practitioner - Physician Assistant 0749656296 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wakemed Specialists Group LLCGroup PAC ID 2466788377, 868 clinicians
Kettering Independent Medical Group IncGroup PAC ID 3173710936, 699 clinicians

Practice addresses (Care Compare)

10000 Falls of Neuse Rd
Raleigh, NC 27614-7838
Phone (919) 350-8000

1900 Kildaire Farm Rd
Cary, NC 27518-6616
Phone (919) 350-8000

3000 New Bern Ave
Raleigh, NC 27610-1231
Phone (919) 350-7270

3533 Southern Blvd
Suite 2100
Kettering, OH 45429-1267
Phone 93739585561267

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0010-12258NCMDSurgical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group, Inc. Physician Assistant CurrentSince Oct 1, 2022 Accepting new patients
Wakemed Specialists Group LLC CurrentSince Jul 22, 2024 Accepting new patients
Summit Medical Group, Inc. CurrentSince Oct 1, 2022 Accepting new patients
Wakemed Specialists Group LLC CurrentSince Jul 22, 2024 Accepting new patients

Locations

20 Medical Village Dr
Edgewood, KY 41017
Phone (859) 344-1600

4900 Houston Rd
Florence, KY 41042
Phone (859) 212-5200

300 Barnes Rd
Williamstown, KY 41097
Phone (859) 824-8217

210 Ashville Ave
Cary, NC 27518
Phone (919) 235-6460

3000 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-7000

3024 New Bern Ave
Raleigh, NC 27610
Phone (919) 350-5318

Interoperability endpoints

  • Direct secure messaging: hgoodrum556060@directhisp.wakemed.org

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 4

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1657065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774915200000",
    "number": "1073246203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3024 NEW BERN AVE",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276101247",
            "telephone_number": "919-350-7331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 ASHVILLE AVE",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275186676",
            "telephone_number": "919-350-9355",
            "fax_number": "919-851-6757"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3533 Southern Blvd Ste 2100",
            "address_purpose": "LOCATION",
            "city": "Kettering",
            "state": "OH",
            "postal_code": "454291267",
            "country_code": "US",
            "telephone_number": "937-395-8556",
            "fax_number": "937-522-9810",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOODRUM",
        "first_name": "HANNAH",
        "middle_name": "LEIGH",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-07-06",
        "last_updated": "2026-03-31",
        "certification_date": "2026-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0102X",
            "taxonomy_group": "",
            "desc": "Surgery, Surgical Critical Care",
            "state": "NC",
            "license": "0010-12258",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-12258",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NC",
            "license": "0010-12258",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1073246203",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Cary, NC

Sources for this page

Verify at the official NPI Registry.