Edison Uy Lim, MD
Individual provider Active NPI Family Medicine Physician · Cherry Valley, IL
NPI 1215966858 · NPPES record last updated Sep 5, 2014
Key facts
- NPI
- 1215966858
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 036090152 (IL)
- Practice address
- 1572 S Bell School Rd
Cherry Valley, IL 61016-9362 - Phone
- (815) 332-3015
- Fax
- (815) 332-7805
- NPI assigned
- Jul 3, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 1988
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Osf Multi-Specialty Group
Practice addresses (Care Compare)
1572 S Bell School Rd
Cherry Valley, IL 61016-9362
Phone (815) 332-3015
Hospital & facility affiliations
- Osf Healthcare Home Care
- Saint Anthony Medical Center
- Uw Health
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20090210000305 | IL | Practitioner - Family Practice | 4082779913 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036090152 | IL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Osf Multi-Specialty Group | Current |
Accepting new patients | |
| Central PA Pharmacy LLC. | Current | Accepting new patients |
Locations
1572 S Bell School Rd
Cherry Valley, IL 61016
Phone (815) 332-3015
8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050
1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195
5666 E State St
Rockford, IL 61108
Phone (815) 226-2000
6830 Villagreen Vw
Rockford, IL 61107
Phone (815) 282-1339
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 036090152 | IL | Yes |
Addresses
Primary practice location
1572 S Bell School Rd
Cherry Valley, IL 61016-9362
Mailing address
1572 S Bell School Rd
Cherry Valley, IL 61016-9362
Phone (815) 332-3015
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 553180 | Other | IL | MEDICARE GROUP # |
| 036090152 | Medicaid | IL |
Other providers in Cherry Valley, IL
- Jillian Jemison
- Jones Family Chiropractic P.C.
- Jason Dennis Jones
- Julie Logan Counseling, Inc
- Don Kleindl III
- LJ Speech Therapy PLLC
- Logan Health & Healing Center, Inc
- Julie Ann Logan
- Jessey Mathew
- Mo Chara Hospice LLC
All providers in Cherry Valley, IL · Family Medicine Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 5, 2014. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.