Khadidja Goni-Malloumi

Primary specialty

DentistTaxonomy code 122300000X

License

12014097A Issued in IN

Practice address

1547 Ohio Ave
Anderson, IN 46016-1917

Phone

(765) 641-7499

NPI assigned

Jun 30, 2023

Last updated

Jun 30, 2023By the provider in NPPES

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: khadidja.gonimalloumi.p1@direct.meridianhs.nextgenshare.com

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.

• Meridian Health Services Corp

  • Federally Qualified Health Center (FQHC)
  • Elwood, IN
  • NPI 1730645631
  NPD (past)
• Meridian Health Services Corp

  • Federally Qualified Health Center (FQHC)
  • Anderson, IN
  • NPI 1841756749
  NPD (past)

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

{
    "created_epoch": "1688083200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1688083200000",
    "number": "1699452649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8950 BRADWELL PL APT 205",
            "city": "FISHERS",
            "state": "IN",
            "postal_code": "460378619",
            "telephone_number": "202-853-4838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1547 OHIO AVE",
            "city": "ANDERSON",
            "state": "IN",
            "postal_code": "460161917",
            "telephone_number": "765-641-7499"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "240 N Tillotson Ave",
            "address_purpose": "LOCATION",
            "city": "Muncie",
            "state": "IN",
            "postal_code": "473043988",
            "country_code": "US",
            "telephone_number": "765-288-1928",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GONI-MALLOUMI",
        "first_name": "KHADIDJA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-30",
        "last_updated": "2023-06-30",
        "certification_date": "2023-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "IN",
            "license": "12014097A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mendi Lynn Godbey
• Tiffany N Godfrey, APRN, FNP-C
• Kristin Golden, FNP-C
• Audrey Goldman
• Catherine Margaret Goldman, NP
• Jason William Good, ATC
• Jerri Goodman, CRNA
• Rhonda A Goodpaster
• Stephanie Marie Goodpaster, FNP
• Gina M Goodwin

• Dentist in Anderson, IN
• Providers in Anderson, IN by specialty
• Dentist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2023; 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.