Krystal Goudreau, RN

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

4704260602 Issued in MI

Practice address

113 N Lake St
Manistique, MI 49854-1234

Phone

(906) 450-1700

NPI assigned

Apr 25, 2017

Last updated

Aug 9, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

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, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Complexcare Medical Group Midwest H PLLCGroup PAC ID 0143737148, 128 clinicians

Theoria MedicalGroup PAC ID 5395098339, 317 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Schoolcraft Memorial Hospital Hospital, Manistique, MI, CCN 231303

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner, Registered Nurse

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir-myrecord.cerner.com/r4/71812193-7aa5-42d8-ba4c-ee45e2ea853f/

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.

• Complexcare Medical Group Midwest H PLLC

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1457144933
  Medicare reassignment Care Compare group NPD
• Theoria Medical

  • Internal Medicine Physician
  • Novi, MI
  • NPI 1609362375
  Medicare reassignment Care Compare group NPD
• Longevity Accountable Care, PA

  • Geriatric Medicine (Family Medicine) Physician
  • Dearborn Heights, MI
  • NPI 1396584447
  Medicare reassignment NPD
• Signify Health Medical Associates, PLLC

  • General Practice Physician
  • Dallas, TX
  • NPI 1750845863

  MI

  Medicare reassignment NPD
• Total Extended Care Services PC

  • Physical Medicine & Rehabilitation Physician
  • Englewood, OH
  • NPI 1699522029

  MI

  Medicare reassignment NPD
• Longevity Accountable Care, PA

  • Geriatric Medicine (Family Medicine) Physician
  • Salisbury, NC
  • NPI 1396584454
  NPD
• Longevity Clinical LTC Associates of Florida PLLC

  • Primary Care Nurse Practitioner
  • Lauderhill, FL
  • NPI 1639743750
  NPD
• Schoolcraft Memorial Hospital

  dba Schoolcraft Memorial HomeCare and Hospice

  • Home Health Agency
  • Manistique, MI
  • NPI 1447256276
  NPD (past)
• Wellbridge of Clarkston, LLC

  • Skilled Nursing Facility
  • Independence Township, MI
  • NPI 1669965299
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Schoolcraft Memorial Hospital

  • Critical Access Hospital
  • Manistique, MI
  • NPI 1700805157
  Care Compare affiliation

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

{
    "created_epoch": "1493078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1691539200000",
    "number": "1609301829",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "113 N LAKE ST",
            "city": "MANISTIQUE",
            "state": "MI",
            "postal_code": "498541234",
            "telephone_number": "906-450-1700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 N LAKE ST",
            "city": "MANISTIQUE",
            "state": "MI",
            "postal_code": "498541234",
            "telephone_number": "906-450-1700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOUDREAU",
        "first_name": "KRYSTAL",
        "credential": "RN",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-04-25",
        "last_updated": "2023-08-09",
        "certification_date": "2023-08-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MI",
            "license": "4704260602",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "MI",
            "license": "4704260602",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• John Patrick Galey, MD
• Barbara Gauger, MSW
• Sandra Giammona, R.N.
• Kristi Lynn Gibson Kusnier, MD
• Nicholas T Golba, DDS
• Great Lakes Recovery Centers
• Denise Greff, RDN
• Neil Eugene Grossnickle, MD
• Mandy L Gwaltney
• Connie Hadel

• Family Nurse Practitioner in Manistique, MI
• Providers in Manistique, MI by specialty
• Family Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2023; 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.