Renato Bacol Rivera, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

036045712 Issued in IL

Practice address

9515 Holy Cross LN Ste 175
Breese, IL 62230-3618

Phone

(618) 526-8430

Fax

(618) 526-7275

NPI assigned

Jul 7, 2005

Last updated

Oct 11, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

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.

• HSHS Prairie, Inc

  dba HSHS Prairie Foot and Ankle - Jacksonville

  • Durable Medical Equipment & Medical Supplies
  • Jacksonville, IL
  • NPI 1629465414
  NPD (past)

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1791676800000",
    "number": "1083612790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9401 HOLY CROSS LN",
            "address_2": "SUITE 111",
            "city": "BREESE",
            "state": "IL",
            "postal_code": "622303510",
            "telephone_number": "618-526-7133",
            "fax_number": "618-526-7160"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9515 HOLY CROSS LN STE 175",
            "city": "BREESE",
            "state": "IL",
            "postal_code": "622303618",
            "telephone_number": "618-526-8430",
            "fax_number": "618-526-7275"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIVERA",
        "first_name": "RENATO",
        "middle_name": "BACOL",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-07",
        "last_updated": "2026-10-11",
        "certification_date": "2021-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "036045712",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036045712",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rrivera157814@ewd.direct.hshs.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "9515 Holy Cross Ln Ste 175",
            "city": "Breese",
            "state": "IL",
            "country_code": "US",
            "postal_code": "622303618",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Emily Rhoades, NP
• Bethany Ricciardi, LCSW
• Dennis Joseph Riechman, FNP-BC
• Right From the Start Pediatrics
• Lynn M Rinella, PT
• Erin Robke, DNP, FNP-BC
• Kasey Santel, D.M.D.
• Lucy Hanson Schrage, M.A., L.C.P.C, A.T.R
• Saif Shaikh, MD
• Danielle L Shubert, PNP

• Surgery Physician in Breese, IL
• Providers in Breese, IL by specialty
• Surgery Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.