Individual provider Active NPI

Jocelyn Redondo Go-Lim, MD

  • Family Medicine Physician
  • Cherry Valley, IL
National Provider Identifier
1255376471
Registry record updated Sep 19, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036097357 Issued in IL
Practice address
1572 S Bell School Rd
Cherry Valley, IL 61016-9362
Phone
(815) 332-3015
Fax
(815) 332-7805
NPI assigned
Jun 19, 2006
Last updated
Sep 19, 2014By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036097357 IL Primary

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 1

IdentifierTypeStateIssuer
036097357MedicaidIL

Other names 1

  • Jocelyn Redondo Go Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20090211000744 IL Practitioner - Family Practice 3072678820 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1988
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

1572 S Bell School Rd
Cherry Valley, IL 61016-9362
Phone (815) 332-3015

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Central PA Pharmacy LLC. Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Jan 1, 2016 Accepting new patients

Locations

1572 S Bell School Rd
Cherry Valley, IL 61016
Phone (815) 332-3015

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

5666 E State St
Rockford, IL 61108
Phone (815) 226-2000

6830 Villagreen Vw
Rockford, IL 61107
Phone (815) 282-1339

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411084800000",
    "number": "1255376471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1572 S BELL SCHOOL RD",
            "city": "CHERRY VALLEY",
            "state": "IL",
            "postal_code": "610169362",
            "telephone_number": "815-332-3015",
            "fax_number": "815-332-7805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1572 S BELL SCHOOL RD",
            "city": "CHERRY VALLEY",
            "state": "IL",
            "postal_code": "610169362",
            "telephone_number": "815-332-3015",
            "fax_number": "815-332-7805"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GO-LIM",
        "first_name": "JOCELYN",
        "middle_name": "REDONDO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-19",
        "last_updated": "2014-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036097357",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036097357",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOCELYN",
            "last_name": "GO",
            "middle_name": "REDONDO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Cherry Valley, IL

Sources for this page

Verify at the official NPI Registry.