Individual provider Active NPI

Kaylyn Jennie Goranson, DO

  • Family Medicine Physician
  • Centreville, AL
National Provider Identifier
1932843034
Registry record updated Mar 6, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
DO.3658 Issued in AL
Practice address
405 Belcher St
Centreville, AL 35042-2946
Phone
(205) 926-2992
NPI assigned
Apr 25, 2022
Last updated
Mar 6, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 6, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Family Medicine Physician 207Q00000X DO.3658 AL Primary

Addresses

Primary practice location

405 Belcher St
Centreville, AL 35042-2946

Mailing address

405 Belcher St
Centreville, AL 35042-2946
Phone (205) 926-2992

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20241223000174 AL Practitioner - Family Practice 7911389036 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Rowan University School of Osteopathic Medicine, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Cahaba Medical Care FoundationGroup PAC ID 1355597923, 100 clinicians

Practice addresses (Care Compare)

195 Hospital Dr
Centreville, AL 35042-2935
Phone (205) 926-2992

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
DO.3658ALMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Cahaba Medical Care Foundation CurrentSince Dec 3, 2024 Accepting new patients
Cahaba Medical Care Foundation CurrentSince Dec 3, 2024 Accepting new patients

Locations

195 Hospital Dr
Centreville, AL 35042
Phone (205) 225-7455

405 Belcher St
Centreville, AL 35042
Phone (205) 926-4694

Interoperability endpoints

  • Direct secure messaging: kaylyn.goranson.1@11347.direct.athenahealth.com

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1650844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1741219200000",
    "number": "1932843034",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "405 BELCHER ST",
            "city": "CENTREVILLE",
            "state": "AL",
            "postal_code": "350422946",
            "telephone_number": "205-926-2992"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 BELCHER ST",
            "city": "CENTREVILLE",
            "state": "AL",
            "postal_code": "350422946",
            "telephone_number": "205-926-2992"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GORANSON",
        "first_name": "KAYLYN",
        "middle_name": "JENNIE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-04-25",
        "last_updated": "2025-03-06",
        "certification_date": "2025-03-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AL",
            "license": "DO.3658",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Centreville, AL

Sources for this page

Verify at the official NPI Registry.