Kiley Nicole Gooden, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

0010-12095 Issued in NC

Practice address

210 Ashville Ave
Cary, NC 27518-6676

Phone

(919) 350-7331

NPI assigned

Jun 8, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Kiley Nicole O'Connor Former name

Medicare fee-for-service enrollment

Enrolled in NC

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

Physician Assistant

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Wakemed Specialists Group LLCGroup PAC ID 2466788377, 868 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wakemed, Raleigh Campus Hospital, Raleigh, NC, CCN 340069
• Wakemed, Cary Hospital Hospital, Cary, NC, CCN 340173

Medicare enrollment (NPD)

Enrolled

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.

• Wakemed Specialists Group, LLC

  • Cardiovascular Disease Physician
  • Raleigh, NC
  • NPI 1588227839
  Medicare reassignment Care Compare group
• Wound Care NC, PLLC

  • Surgical Physician Assistant
  • Raleigh, NC
  • NPI 1851694160
  Medicare reassignment
• Raleigh Emergency Surgical, Inc

  • Surgery Physician
  • Raleigh, NC
  • NPI 1427872548
  NPD
• Wakemed Specialists Group LLC

  • Cardiac Rehabilitation Registered Nurse
  • Raleigh, NC
  • NPI 1063304228
  NPD
• Wakemed Specialists Group, LLC

  • Neonatal-Perinatal Medicine Physician
  • Raleigh, NC
  • NPI 1649834102
  NPD

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

• Wakemed

  • General Acute Care Hospital
  • Cary, NC
  • NPI 1114993086
  Care Compare affiliation
• Wakemed

  • Psychiatric Hospital Unit
  • Raleigh, NC
  • NPI 1780446302
  Care Compare affiliation
• Wakemed

  • General Acute Care Hospital
  • Raleigh, NC
  • NPI 1972579837
  Care Compare affiliation

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

{
    "created_epoch": "1623110400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698710400000",
    "number": "1760059661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 603949",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282603949",
            "telephone_number": "919-350-0351",
            "fax_number": "919-350-7687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 ASHVILLE AVE",
            "city": "CARY",
            "state": "NC",
            "postal_code": "275186676",
            "telephone_number": "919-350-7331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODEN",
        "first_name": "KILEY",
        "middle_name": "NICOLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-06-08",
        "last_updated": "2023-10-31",
        "certification_date": "2023-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-12095",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NC",
            "license": "0010-12095",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1760059661",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KILEY",
            "last_name": "O'CONNOR",
            "middle_name": "NICOLE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Good Samaritan Transit
• Good Vibes Home Care LLC
• Brian Goodale
• Christina Rhea Goodall, D.D.S.
• Kayla M Goode
• Katherine J Gooding
• Kobianne P Goodloe
• Katherine Marie Goodman
• Rachel Goodman, FNP
• Hannah Leigh Goodrum, PA-C

• Surgical Physician Assistant in Cary, NC
• Providers in Cary, NC by specialty
• Surgical Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 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.