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Individual provider Active NPI

Taryna J Goodman, NP

  • Family Nurse Practitioner
  • Twin Falls, ID
National Provider Identifier
1104928878
Registry record updated Jan 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
NP-767 Issued in ID
Practice address
496 Shoup Ave. W
Suite E
Twin Falls, ID 83301-5043
Phone
(208) 733-2885
Fax
(208) 734-3352
NPI assigned
Sep 2, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 25, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X NP-767 ID Primary

Addresses

Primary practice location

496 Shoup Ave. W
Suite E
Twin Falls, ID 83301-5043

Mailing address

496 Shoup Ave W
Suite E
Twin Falls, ID 83301-5043
Phone (208) 733-2885

Other identifiers 1

IdentifierTypeStateIssuer
807733300MedicaidID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in ID
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070817000437 ID Practitioner - Nurse Practitioner 3870694326 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
North Canyon Medical Center IncGroup PAC ID 0941371439, 73 clinicians

Practice addresses (Care Compare)

134 4TH Ave W
Gooding, ID 83330-1018
Phone (208) 934-4446

267 N Canyon Dr
Gooding, ID 83330-5500
Phone (208) 934-4433

491 Heritage Dr
Jerome, ID 83338-6701
Phone (208) 644-7500

Hospital & facility affiliations

  • North Canyon Medical Center Hospital, Gooding, ID, CCN 131302
  • St Lukes Magic Valley Medical Center Hospital, Twin Falls, ID, CCN 130002
  • St Luke'S Jerome Hospital, Jerome, ID, CCN 131310
  • St Luke'S Regional Medical Center Hospital, Boise, ID, CCN 130006

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
NP-767IDMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
North Canyon Medical Center, Inc. CurrentSince Jan 27, 2021 Accepting new patients
North Canyon Medical Center Inc. CurrentSince Jan 27, 2021 Accepting new patients
North Canyon Medical Center, Inc. CurrentSince Jan 27, 2021 Accepting new patients
Inland Cardiology Associates, P.S. Past Accepting new patients
Sara L. Johnson, MD PastSince Jul 7, 2018 Accepting new patients

Locations

718 Highway 30
Buhl, ID 83316
Phone (208) 543-4785

267 N Canyon Dr
Gooding, ID 83330
Phone (208) 934-4433

267 N Canyon Dr
Ste 1
Gooding, ID 83330

491 Heritage Dr
Jerome, ID 83338
Phone (208) 644-7500

Organizations & group practices 9

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 5

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": "1157155200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1359072000000",
    "number": "1104928878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "496 SHOUP AVE W",
            "address_2": "SUITE E",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015043",
            "telephone_number": "208-733-2885",
            "fax_number": "208-734-3352"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "496 SHOUP AVE. W",
            "address_2": "SUITE E",
            "city": "TWIN FALLS",
            "state": "ID",
            "postal_code": "833015043",
            "telephone_number": "208-733-2885",
            "fax_number": "208-734-3352"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "TARYNA",
        "middle_name": "J",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-02",
        "last_updated": "2013-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "NP-767",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "807733300",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Twin Falls, ID

Sources for this page

Verify at the official NPI Registry.