Individual provider Active NPI

Mollie Goodman, NP

  • Family Nurse Practitioner
  • San Francisco, CA
National Provider Identifier
1114295458
Registry record updated Mar 10, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
17102 Issued in CA
Practice address
2238 Geary Blvd
5TH Floor
San Francisco, CA 94115-3416
Phone
(415) 833-2000
NPI assigned
Dec 1, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 10, 2022

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 17102 CA Primary

Addresses

Primary practice location

2238 Geary Blvd
5TH Floor
San Francisco, CA 94115-3416

Mailing address

2238 Geary Blvd
5TH Floor
San Francisco, CA 94115-3416
Phone (415) 595-2304

Other identifiers 1

IdentifierTypeStateIssuer
1326265125OtherCAPAST NPI NUMBER (THROUGH PROVIDER)

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq Health Information Exchange (HIE) The Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20120507000300 CA Practitioner - Nurse Practitioner 1153583299 Reassigns benefits to 1 organization

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
Permanente Medical Group IncGroup PAC ID 8921910225, 10,928 clinicians

Practice addresses (Care Compare)

2200 Ofarrell St
San Francisco, CA 94115-3357
Phone (415) 833-2000

2238 Geary Blvd
San Francisco, CA 94115-3416
Phone (415) 833-2200

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Permanente Medical Group Inc Current Accepting new patients
Permanente Medical Group, Inc CurrentSince Mar 18, 2012 Accepting new patients
Permanente Medical Group Inc CurrentSince Mar 18, 2012 Accepting new patients

Locations

1600 Owens St
San Francisco, CA 94158
Phone (415) 833-2200

2238 Geary Blvd
Fl 5
San Francisco, CA 94115
Phone (415) 203-2952

2200 Ofarrell St
San Francisco, CA 94115
Phone (415) 202-2000

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1322697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1646870400000",
    "number": "1114295458",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2238 GEARY BLVD",
            "address_2": "5TH FLOOR",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941153416",
            "telephone_number": "415-595-2304"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2238 GEARY BLVD",
            "address_2": "5TH FLOOR",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941153416",
            "telephone_number": "415-833-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "MOLLIE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-12-01",
        "last_updated": "2022-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "17102",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PAST NPI NUMBER (THROUGH PROVIDER)",
            "identifier": "1326265125",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "1600 Owens St",
            "city": "San Francisco",
            "state": "CA",
            "country_code": "US",
            "postal_code": "941582261",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in San Francisco, CA

Sources for this page

Verify at the official NPI Registry.