Individual provider Active NPI

Thomas Golemon, MD

  • Family Medicine Physician
  • Peoria, IL
National Provider Identifier
1619981370
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Practice address
815 Main St
Peoria, IL 61602-1076
Phone
(309) 672-4977
NPI assigned
Jul 28, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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 IL Primary

Addresses

Primary practice location

815 Main St
Peoria, IL 61602-1076

Mailing address

5100 Reliable Pkwy
Chicago, IL 60686-0001
Phone (309) 672-4809

Other identifiers 5

IdentifierTypeStateIssuer
008424OtherILHEALTH ALLIANCE
0360784678MedicaidIL
IL01P6OtherILJOHN DEERE
7215059OtherILBCBS PPO
472301OtherILHEALTHLINK

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
I20040303000611 IL Practitioner - Family Practice 9739076779 Reassigns benefits to 2 organizations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036078467ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Methodist Medical Center of Illinois Current Accepting new patients
Proctor Health Systems Family Medicine CurrentSince Jan 13, 2018 Accepting new patients
Methodist Medical Center of Illinois CurrentSince Jan 13, 2018 Accepting new patients
Proctor Health Systems Family Medicine CurrentSince Jan 13, 2018 Accepting new patients
Methodist Medical Center of Illinois Family Medicine Past Accepting new patients

Locations

5100 Reliable Pkwy
Chicago, IL 60686
Phone (309) 672-4809

112 NE Crescent Ave
Peoria, IL 61606
Phone (309) 680-2402

815 Main St
Ste A
Peoria, IL 61602
Phone (309) 672-4986

221 NE Glen Oak Ave
Peoria, IL 61636
Phone (309) 672-4281

815 Main St
Ste A1
Peoria, IL 61602

815 Main St
Peoria, IL 61602
Phone (309) 672-4908

5401 N Knoxville Ave
Ste 400
Peoria, IL 61614
Phone (309) 691-6610

Organizations & group practices 5

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": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1619981370",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5100 RELIABLE PKWY",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606860001",
            "telephone_number": "309-672-4809"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "815 MAIN ST",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616021076",
            "telephone_number": "309-672-4977"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLEMON",
        "first_name": "THOMAS",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "008424",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0360784678",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "IL01P6",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PPO",
            "identifier": "7215059",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "472301",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.