CMS-1500 Box 24J / 33a • NPI
1629798822
Type 1 Individual Rendering/Ordering
HIPAA NUCC Taxonomy • CMS Code
363LF0000X (CMS 50)
Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family
Box 32 Service Location & ZIP+4
435 MAXINE DR, MORTON, IL, 61550-2498
✓ 9-Digit EDI 837 ZIP+4 (61550-2498)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1629798822 (KYRA LYN PINEDA GOODELL, APRN,CNP) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Medicare Part B
✓ Eligible
DMEPOS Ordering
✓ Eligible
Home Health (HHA)
✓ Eligible
Power Mobility
✓ Eligible
Hospice Referring
No
Empirical CMS Medicare Claims, CPT Utilization & Part D Prescribing (NPI #1629798822)
Medicare Beneficiaries
215
Total Billed Services
438
Distinct CPT/HCPCS Codes
32
Medicare Allowed Total
$36,013.98
Actual Top Billed CPT / HCPCS Procedures (CMS Part B)
| CPT / HCPCS | Clinical Procedure Description | Services |
|---|---|---|
36415 | Insertion of needle into vein for collection of blood sample | 15 |
90653 | Influenza vaccine, inactivated | 11 |
99213 | Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more | 73 |
99214 | Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more | 176 |
99215 | Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more | 17 |
99495 | Transitional care management services for problem of at least moderate complexity | 21 |
G0008 | Administration of influenza virus vaccine | 12 |
G2211 | Visit complexity inherent to evaluation and management associated with medical care services that serve as the continuing focal point for all needed health care services and/or with medical care services that are part of ongoing care related to a patient's | 40 |
Actual Top Prescribed Medications (CMS Part D)
| Brand / Generic Medication | Total Claims | Patients |
|---|---|---|
| Albuterol Sulfate Hfa Albuterol Sulfate | 23 | 16 |
| Allopurinol Allopurinol | 18 | <11 |
| Amlodipine Besylate Amlodipine Besylate | 47 | 28 |
| Atorvastatin Calcium Atorvastatin Calcium | 62 | 28 |
| Baclofen Baclofen | 12 | <11 |
| Buspirone Hcl Buspirone Hcl | 12 | <11 |
| Cephalexin Cephalexin | 11 | <11 |
| Diltiazem 24hr Er (Cd) Diltiazem Hcl | 18 | <11 |
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1629798822 (NPI-1 Individual Practitioner) |
|---|---|
| Provider / Legal Name | KYRA LYN PINEDA GOODELL, APRN,CNP |
| Plain-English Specialty | Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family NUCC Code: 363LF0000X (Nurse Practitioner, Family) |
| Certifying / Licensing Body | State Medical / Healthcare Licensing Board & National Specialty Board |
| Practice Location Address | 435 MAXINE DR, MORTON, IL, 61550-2498 |
| Practice Telephone / Fax | Tel: (309) 263-2424 |
| Administrative Mailing Address | 4922 N RONALD RD, PEORIA, IL, 61614-4520 |
| Enumeration & Last Sync | Enumerated: 2022-08-30 | CMS Record Updated: 2023-06-14 |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
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Plain-English Taxonomy & CMS Crosswalk (363LF0000X)
What Does Taxonomy Code 363LF0000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 363LF0000X translates to:
"Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (KYRA LYN PINEDA GOODELL, APRN,CNP)
Typical CPT / Diagnostic Procedures:- Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
- Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
- Preventive Screening, Patient Counseling & Multidisciplinary Referral
- Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
163W00000X — Registered NursePlain English: Licensed & Credentialed Registered Nurse | State: IL | License: 041444483 | Primary: Secondary |
363LF0000X — Nurse Practitioner, FamilyPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family | State: IL | License: 041444483 | Primary: Secondary |
363LP2300X — Nurse Practitioner, Primary CarePlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Primary Care | State: IL | License: 209.0258230 | Primary: Secondary |
363LF0000X — Nurse Practitioner, FamilyPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner, Family | State: IL | License: 209025830 | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
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