NPIMap

Individual provider Active NPI

Bradley Goll

  • Certified Registered Nurse Anesthetist
  • Omak, WA
National Provider Identifier
1770121089
Registry record updated Dec 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
50150 Issued in ID
Practice address
810 Jasmine St
Omak, WA 98841-9578
Phone
(509) 826-1760
NPI assigned
Dec 17, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 17, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Certified Registered Nurse Anesthetist 367500000X 50150 ID Primary

Addresses

Primary practice location

810 Jasmine St
Omak, WA 98841-9578

Mailing address

1073 N Hiltonhead Way
Eagle, ID 83616-5460

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200407001733 WA Practitioner - Certified Registered Nurse Anesthetist (Crna) 3476982794 Reassigns benefits to 9 organizations

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grant County Public Hospital District 1Group PAC ID 9931095692, 112 clinicians
Public Hospital District No 1 of Mason CountyGroup PAC ID 0345139275, 60 clinicians

Practice addresses (Care Compare)

2000 S Clover Dr
Moses Lake, WA 98837-4417
Phone (509) 765-5606

901 Mountain View Dr
Suite 1
Shelton, WA 98584-4401
Phone (360) 427-3625

Hospital & facility affiliations

  • Samaritan Hospital Hospital, Moses Lake, WA, CCN 500033
  • Mason General Hospital & Family of Clinics Hospital, Shelton, WA, CCN 501336

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
50150IDMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Okanogan Douglas County Hospital Dist1 CurrentSince Mar 1, 2020 Accepting new patients
Public Hospital District No 1 of Mason County Wa CurrentSince Jun 11, 2024 Accepting new patients
Public Hospital District No 3 of Whitman County CurrentSince May 1, 2024 Accepting new patients
Okanogan County Public Hospital Dist No 4 Current Accepting new patients
Okanogan County Public Hospital Dist No 4 CurrentSince Mar 10, 2020 Accepting new patients
Public Hospital District No 1 of Mason County Nurse Anesthetist, Certified Registered CurrentSince Jun 11, 2024 Accepting new patients
Grant County Public Hospital District 1 CurrentSince Jan 17, 2023 Accepting new patients
Okanogan Douglas County Hospital Dist 1 CurrentSince Mar 1, 2020 Accepting new patients
Okanogan County Public Hospital Dist No 4 CurrentSince Mar 10, 2020 Accepting new patients
Okanogan County Public Hospital District No. 3 CurrentSince Mar 25, 2020 Accepting new patients
Grant County Public Hospital District 1 Current Accepting new patients
Grant County Public Hospital District 1 CurrentSince Jan 17, 2023 Accepting new patients

Locations

400 10th St E
Waconia, MN 55387

1200 W Fairview St
Colfax, WA 99111
Phone (509) 397-3435

660 S Coolidge St
Moses Lake, WA 98837

2000 S Clover Dr
Moses Lake, WA 98837
Phone (509) 765-5606

801 E Wheeler Rd
Moses Lake, WA 98837
Phone (509) 765-5606

810 Jasmine St
Omak, WA 98841
Phone (509) 826-1760

901 Mountain View Dr
Bldg 1
Shelton, WA 98584
Phone (360) 426-1611

126 S Whitcomb Ave
Tonasket, WA 98855
Phone (509) 486-2151

203 S Western Ave
Tonasket, WA 98855
Phone (509) 486-2151

Organizations & group practices 12

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1576540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576540800000",
    "number": "1770121089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1073 N HILTONHEAD WAY",
            "city": "EAGLE",
            "state": "ID",
            "postal_code": "836165460"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "810 JASMINE ST",
            "city": "OMAK",
            "state": "WA",
            "postal_code": "988419578",
            "telephone_number": "509-826-1760"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLL",
        "first_name": "BRADLEY",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-12-17",
        "last_updated": "2019-12-17",
        "certification_date": "2019-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "ID",
            "license": "50150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Omak, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.