NPIMap

Individual provider Active NPI

Sherrie Cecile Godbolt, M.D.

  • Psychiatry Physician
  • South Holland, IL
National Provider Identifier
1114027828
Registry record updated Jan 14, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
036098066 Issued in IL
Practice address
15475 S Park Ave
Suite 111
South Holland, IL 60473-1328
Phone
(708) 362-5084
Fax
(708) 596-6985
NPI assigned
Sep 23, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 14, 2013

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry Physician 2084P0800X 036098066 IL Primary
Psychiatry Physician 2084P0800X 01048641A IN
Geriatric Psychiatry Physician 2084P0805X 036098066 IL
Geriatric Psychiatry Physician 2084P0805X 01048641A IN

Addresses

Primary practice location

15475 S Park Ave
Suite 111
South Holland, IL 60473-1328

Mailing address

15475 S Park Ave
Suite 111
South Holland, IL 60473-1328
Phone (708) 362-5084

Other identifiers 3

IdentifierTypeStateIssuer
200197180MedicaidIN
036098066MedicaidIL
01625468OtherILBCBS PROVIDER ID

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036098066ILMDPsychiatry Physician
01048641AINMDGeriatric Psychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The McGrath Clinic Past Accepting new patients
Clark Nursing and Rehabilitation Center, LLC Past Accepting new patients
Associated Behavioral Therapeutics Inc Past Accepting new patients
The McGrath Clinic S C PastSince Aug 2, 2004 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: sherrie.godbolt.1@13826.direct.athenahealth.com

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.

NPI Registry JSON

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

{
    "created_epoch": "1158969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1358121600000",
    "number": "1114027828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15475 S PARK AVE",
            "address_2": "SUITE 111",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604731328",
            "telephone_number": "708-362-5084",
            "fax_number": "708-596-6985"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15475 S PARK AVE",
            "address_2": "SUITE 111",
            "city": "SOUTH HOLLAND",
            "state": "IL",
            "postal_code": "604731328",
            "telephone_number": "708-362-5084",
            "fax_number": "708-596-6985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GODBOLT",
        "first_name": "SHERRIE",
        "middle_name": "CECILE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-23",
        "last_updated": "2013-01-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IL",
            "license": "036098066",
            "primary": true
        },
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "IN",
            "license": "01048641A",
            "primary": false
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "IL",
            "license": "036098066",
            "primary": false
        },
        {
            "code": "2084P0805X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Geriatric Psychiatry",
            "state": "IN",
            "license": "01048641A",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200197180",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036098066",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PROVIDER ID",
            "identifier": "01625468",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in South Holland, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 14, 2013; 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.