Jordan Goodman, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036-081034 Issued in IL

Practice address

656 N Convent St Ste B
Bourbonnais, IL 60914-1393

Phone

(815) 936-5186

Fax

(815) 936-5190

NPI assigned

Oct 26, 2006

Last updated

Aug 8, 2018By 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

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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.

• Gibson Community Hospital Association

  dba Gibson Area Hospital and Health Services

  • Critical Access Hospital
  • Gibson City, IL
  • NPI 1114935681
  NPD (past)

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

{
    "created_epoch": "1161820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1533686400000",
    "number": "1538244389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1000 REMINGTON BLVD STE 100",
            "city": "BOLINGBROOK",
            "state": "IL",
            "postal_code": "604404707",
            "fax_number": "630-914-2469"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "656 N CONVENT ST STE B",
            "city": "BOURBONNAIS",
            "state": "IL",
            "postal_code": "609141393",
            "telephone_number": "815-936-5186",
            "fax_number": "815-936-5190"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "455 W Court St Ste 400",
            "address_purpose": "LOCATION",
            "city": "Kankakee",
            "state": "IL",
            "postal_code": "609013695",
            "country_code": "US",
            "telephone_number": "815-937-8744",
            "fax_number": "815-937-3528",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "692 N. Maple",
            "address_purpose": "LOCATION",
            "city": "Herscher",
            "state": "IL",
            "postal_code": "60941",
            "country_code": "US",
            "telephone_number": "815-426-2020",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "JORDAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-26",
        "last_updated": "2018-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-081034",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jesse Ann Gillette, LSW
• Lea Gindville
• Giovanni Salerno MD PC
• Cynthia L Goldrick, P.A.-C
• Kathleen Marie Goldsmith, RN, NP-C
• Nicky C Graham
• Kyla Graska
• Sydney Graska
• Taryn Lyn Gray, APRN
• Barbara Grgurich, LSW

• Family Medicine Physician in Bourbonnais, IL
• Providers in Bourbonnais, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 8, 2018; 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.