Mikaela R Goodwater, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

APN.1000278-NP Issued in CO

Practice address

715 S 9TH St
Canon City, CO 81212-4911

Phone

(719) 269-8820

NPI assigned

Oct 30, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Mikaela R Carlock Former name

Medicare fee-for-service enrollment

Enrolled in CO

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

Specialty

Nurse Practitioner

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Alpine Medical Group Colorado PLLCGroup PAC ID 1759743347, 101 clinicians

Button Family Practice PCGroup PAC ID 0840225413, 9 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

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.

• Alpine Medical Group Colorado PLLC

  dba Colorado Physicians Partners

  • Family Medicine Physician
  • Denver, CO
  • NPI 1104501873
  Medicare reassignment Care Compare group NPD
• Button Family Practice PC

  • Rural Health Clinic/Center
  • Canon City, CO
  • NPI 1144269739
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1730246400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1738886400000",
    "number": "1154143089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "715 S 9TH ST",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812124911",
            "telephone_number": "719-269-8820"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "715 S 9TH ST",
            "city": "CANON CITY",
            "state": "CO",
            "postal_code": "812124911",
            "telephone_number": "719-269-8820"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODWATER",
        "first_name": "MIKAELA",
        "middle_name": "R",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-10-30",
        "last_updated": "2025-02-07",
        "certification_date": "2025-02-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CO",
            "license": "APN.1000278-NP",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MIKAELA",
            "last_name": "CARLOCK",
            "middle_name": "R",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• William Shaun Gogarty, M.D.
• Britt Taylene Gomer, MS CCC-SLP
• Ramona L Gonzales, BS
• Goodneighbor (Goodneighbor LLC)
• Goodneighbor, LLC
• Sidney Brent Goodwin, O.D.
• Terri L. Gorman, L.C.S.W.
• Kristy Gotham
• James Gowdy
• Rhonda Graham, MA, LPC, CAS

• Family Nurse Practitioner in Canon City, CO
• Providers in Canon City, CO by specialty
• Family Nurse Practitioner in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 7, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.