Individual provider Active NPI

Patricia L. Good, NP

  • Primary Care Nurse Practitioner
  • San Clemente, CA
National Provider Identifier
1255757217
Registry record updated May 13, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Nurse PractitionerTaxonomy code 363LP2300X
License
3008647 Issued in KY
Practice address
2719 S El Camino Real
San Clemente, CA 92672-3354
Phone
(949) 484-9517
Fax
(949) 569-1295
NPI assigned
Mar 13, 2014
Last updated
May 13, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 13, 2025

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X AG0314007 OH
Adult Health Nurse Practitioner 363LA2200X APRN.CNP.15767 OH
Primary Care Nurse Practitioner 363LP2300X APRN.CNP.15756 OH
Primary Care Nurse Practitioner 363LP2300X 3008647 KY Primary

Addresses

Primary practice location

2719 S El Camino Real
San Clemente, CA 92672-3354

Mailing address

2035 Jacobs Run Rd
New Richmond, OH 45157-9307
Phone (937) 725-5522

Other practice location 1

21 E State St Ste 200
Columbus, OH 43215-0109
Phone (800) 731-8994

Other practice location 2

312 S 4th St Ste 700
Louisville, KY 40202-3046
Phone (888) 731-8994

Other names 1

  • Patricia Backus Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20150121001080 KY Practitioner - Nurse Practitioner 6608099791 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
AG0314007OHMDAdult Health Nurse Practitioner
APRN.CNP.15767OHMDAdult Health Nurse Practitioner
APRN.CNP.15756OHMDPrimary Care Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Jonathan Larson MD PC Adult Health CurrentSince Sep 1, 2024 Accepting new patients
Integrative Womens Care PC Past Accepting new patients

Locations

3499 Blazer Pkwy
Ste 325
Lexington, KY 40509

2505 Anthem Village Dr
Henderson, NV 89052

2505 Anthem Village Dr
Ste E162
Henderson, NV 89052

Interoperability endpoints

  • Direct secure messaging: patricia.good.1@27069.direct.athenahealth.com

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1394668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747094400000",
    "number": "1255757217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2035 JACOBS RUN RD",
            "city": "NEW RICHMOND",
            "state": "OH",
            "postal_code": "451579307",
            "telephone_number": "937-725-5522"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2719 S EL CAMINO REAL",
            "city": "SAN CLEMENTE",
            "state": "CA",
            "postal_code": "926723354",
            "telephone_number": "949-484-9517",
            "fax_number": "949-569-1295"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "21 E State St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Columbus",
            "state": "OH",
            "postal_code": "432150109",
            "country_code": "US",
            "telephone_number": "800-731-8994",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "312 S 4th St Ste 700",
            "address_purpose": "LOCATION",
            "city": "Louisville",
            "state": "KY",
            "postal_code": "402023046",
            "country_code": "US",
            "telephone_number": "888-731-8994",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOOD",
        "first_name": "PATRICIA",
        "middle_name": "L.",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-13",
        "last_updated": "2025-05-13",
        "certification_date": "2025-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OH",
            "license": "AG0314007",
            "primary": false
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "OH",
            "license": "APRN.CNP.15767",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "OH",
            "license": "APRN.CNP.15756",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "KY",
            "license": "3008647",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PATRICIA",
            "last_name": "BACKUS",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in San Clemente, CA

Sources for this page

Verify at the official NPI Registry.