Kelly Goldsmith, DO

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

License

125.076125 Issued in IL

Practice address

1 Illini Dr
Peoria, IL 61605-2576

Phone

(858) 444-7309

NPI assigned

May 7, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kelly Pauls Former name

Medicare fee-for-service enrollment

Enrolled in MO

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

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.

• Golden Valley Memorial Hospital District

  dba Golden Valley Medical - Clinton

  • Rural Health Clinic/Center
  • Clinton, MO
  • NPI 1003873266
  Medicare reassignment NPD
• Golden Valley Memorial Hospital District

  dba GVMH Medical East

  • Clinic/Center
  • Clinton, MO
  • NPI 1396379830
  NPD
• Golden Valley Memorial Hospital District

  dba Golden Valley Medical - Warsaw

  • Rural Health Clinic/Center
  • Warsaw, MO
  • NPI 1366490971
  NPD (past)

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

{
    "created_epoch": "1588809600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1588809600000",
    "number": "1306468822",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9505 E 203RD ST",
            "city": "PECULIAR",
            "state": "MO",
            "postal_code": "640788792",
            "telephone_number": "858-444-7309"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 ILLINI DR",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616052576",
            "telephone_number": "858-444-7309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDSMITH",
        "first_name": "KELLY",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-05-07",
        "last_updated": "2020-05-07",
        "certification_date": "2020-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "IL",
            "license": "125.076125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "PAULS",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Holly Goins, MSW, LCSW
• Frank Gold, MD
• Daniel Edward Goldenberg, MD
• Stephen Lewis Goldman, MD
• Gabrielle Goldsberry
• Goldwater Care Peoria Heights LLC (Goldwater Care Peoria Heights)
• Joan Golemon, MD
• Thomas Golemon, MD
• Jane A. Golowski, R.N.
• Patrick L. Gomez, MD

• Student in an Organized Health Care Education/Training Program in Peoria, IL
• Providers in Peoria, IL by specialty
• Student in an Organized Health Care Education/Training Program in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.