Individual provider Active NPI

Jean Goodloe, DO

  • Anesthesiology Physician
  • Peoria, IL
National Provider Identifier
1699036574
Registry record updated Oct 13, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
9407809 Issued in KS
Practice address
8600 State Route 91 Ste 250
Peoria, IL 61615-7831
Phone
(309) 692-5393
Fax
(309) 692-2538
NPI assigned
Jun 6, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 13, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 9407809 KS Primary

Addresses

Primary practice location

8600 State Route 91 Ste 250
Peoria, IL 61615-7831

Mailing address

8600 State Route 91 Ste 250
Peoria, IL 61615-7831
Phone (309) 692-5393

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
I20160805002335 IL Practitioner - Anesthesiology 7416104302 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Kansas City University of Physicians and Surgeons, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Methodist Medical Center of IllinoisGroup PAC ID 1355259714, 387 clinicians
Carle Health Care IncorporatedGroup PAC ID 3577515774, 1,592 clinicians

Practice addresses (Care Compare)

221 NE Glen Oak Ave
Peoria, IL 61636-0001
Phone (309) 672-5654

5409 N Knoxville Ave
Peoria, IL 61614-5069
Phone (309) 691-1000

600 S 13TH St
Pekin, IL 61554-4936
Phone (309) 347-1151

611 W Park St
Urbana, IL 61801-2501
Phone (888) 712-2753

Hospital & facility affiliations

  • Carle Health Proctor Hospital Hospital, Peoria, IL, CCN 140013
  • Carle Health Methodist Hospital Hospital, Peoria, IL, CCN 140209
  • Carle Health Pekin Hospital Hospital, Pekin, IL, CCN 140120

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
9407809KSMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Methodist Medical Center of Illinois CurrentSince Jan 19, 2023 Accepting new patients
Associated Anesthesiologists, S.C. Anesthesiology CurrentSince Nov 1, 2017 Accepting new patients
Methodist Medical Center of Illinois Anesthesiology CurrentSince Jan 19, 2023 Accepting new patients
Associated Anesthesiologists, SC Anesthesiology CurrentSince Dec 6, 2020 Accepting new patients
North American Partners in Anesthesia (Illinois), LLC Anesthesiology CurrentSince Jan 1, 2022 Accepting new patients

Locations

3249 Oak Park Ave
Berwyn, IL 60402
Phone (708) 783-2696

6742 N Frostwood Pkwy
Peoria, IL 61615
Phone (309) 692-5393

530neglen Oak Ave
Peoria, IL 61637
Phone (309) 692-5393

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

8600 State Route 91
Ste 250
Peoria, IL 61615
Phone (309) 692-5393

68 S Service Rd
Ste 350
Melville, NY 11747
Phone (516) 945-3107

Organizations & group practices 6

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.

Hospital & facility affiliations 4

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": "1338940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1507852800000",
    "number": "1699036574",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8600 STATE ROUTE 91 STE 250",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616157831",
            "telephone_number": "309-692-5393",
            "fax_number": "309-692-2538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8600 STATE ROUTE 91 STE 250",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616157831",
            "telephone_number": "309-692-5393",
            "fax_number": "309-692-2538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODLOE",
        "first_name": "JEAN",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-06",
        "last_updated": "2017-10-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "KS",
            "license": "9407809",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.