NPIMap

Individual provider Active NPI

Nicole Goodroad, CNP

  • Nurse Practitioner
  • Sioux Falls, SD
National Provider Identifier
1891346136
Registry record updated Dec 11, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
CP001646 Issued in SD
Practice address
911 E 20TH St Ste 700
Sioux Falls, SD 57105-1049
Phone
(605) 334-0393
NPI assigned
Sep 27, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 11, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X CP001646 SD Primary

Addresses

Primary practice location

911 E 20TH St Ste 700
Sioux Falls, SD 57105-1049

Mailing address

911 E 20TH St
Ste 700
Sioux Falls, SD 57105-1049
Phone (605) 334-0393

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SD
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20191202000119 SD Practitioner - Nurse Practitioner 1153754320 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Surgical Institute of South Dakota PCGroup PAC ID 7911896253, 22 clinicians

Practice addresses (Care Compare)

911 E 20TH St
Suite 700
Sioux Falls, SD 57105-1049
Phone (605) 334-0393

Hospital & facility affiliations

  • Avera McKennan Hospital & University Health Center Hospital, Sioux Falls, SD, CCN 430016

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
CP001646SDMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Avera McKennan CurrentSince Mar 1, 2020 Accepting new patients
Surgical Institute of South Dakota, PC CurrentSince Sep 26, 2019 Accepting new patients
Avera McKennan Current Accepting new patients
Avera McKennan CurrentSince Mar 1, 2020 Accepting new patients

Locations

300 W 5th St
Miller, SD 57362
Phone (605) 853-0158

911 E 20th St
Ste 700
Sioux Falls, SD 57105
Phone (605) 322-7300

910 E 20th St
Sioux Falls, SD 57105
Phone (602) 338-7098

Organizations & group practices 4

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 23

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

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1569542400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576022400000",
    "number": "1891346136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "911 E 20TH ST",
            "address_2": "STE 700",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051049",
            "telephone_number": "605-334-0393"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "911 E 20TH ST STE 700",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571051049",
            "telephone_number": "605-334-0393"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODROAD",
        "first_name": "NICOLE",
        "credential": "CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-09-27",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SD",
            "license": "CP001646",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Sioux Falls, SD

Sources for this page

Verify at the official NPI Registry.