Individual provider Active NPI

Merril Roger Goodell, N.P.

  • Gerontology Nurse Practitioner
  • Honolulu, HI
National Provider Identifier
1366771636
Registry record updated Sep 9, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gerontology Nurse PractitionerTaxonomy code 363LG0600X
License
APRN-1231 Issued in HI
Practice address
888 S King St
Honolulu, HI 96813-3009
Phone
(808) 522-3159
Fax
(808) 522-4345
NPI assigned
Dec 16, 2009
Last updated
Sep 9, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 9, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gerontology Nurse Practitioner 363LG0600X APRN-1231 HI Primary

Addresses

Primary practice location

888 S King St
Honolulu, HI 96813-3009

Mailing address

888 S King St
Straub Department of Geriatrics
Honolulu, HI 96813-3009
Phone (808) 522-3159

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
APRN-1231HIMDGerontology Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1260921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283990400000",
    "number": "1366771636",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "888 S KING ST",
            "address_2": "STRAUB DEPARTMENT OF GERIATRICS",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968133009",
            "telephone_number": "808-522-3159",
            "fax_number": "808-522-4345"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "888 S KING ST",
            "city": "HONOLULU",
            "state": "HI",
            "postal_code": "968133009",
            "telephone_number": "808-522-3159",
            "fax_number": "808-522-4345"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODELL",
        "first_name": "MERRIL",
        "middle_name": "ROGER",
        "name_prefix": "Mr.",
        "credential": "N.P.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-12-16",
        "last_updated": "2010-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "HI",
            "license": "APRN-1231",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Honolulu, HI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.