RENATO BACOL RIVERA (NPI# 1083612790) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1083612790 |
| Entity Type | Individual |
| Full Name | RENATO BACOL RIVERA |
| Credential | M.D. |
| Practice Address |
9401 Holy Cross Ln Suite 111 Breese IL 62230-3510 |
| Practice Telephone | 6185267133 |
| Practice Fax Number | 6185267160 |
| Mailing Telephone | 6185267133 |
| Mailing Fax Number | 6185267160 |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2011-06-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208600000X | Surgery | 036045712 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036045712 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760565113 | Renato Luis Rivera | Family Medicine | 168 Calle Guanajibo, Crown Hills, San Juan, PR 00926-6003 | 2006-10-21 |
| 1992787634 | Renato Rivera | Pediatrics | Ave Degetau, San Alfonso, Caguas, PR 00725-5819 | 2005-11-17 |
| Street Address |
9401 HOLY CROSS LN SUITE 111 |
| City | BREESE |
| State | IL |
| Zip Code | 62230-3510 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1417252453 | Amber Leigh Poettker | Physician Assistant | 9401 Holy Cross Ln, Suite 112, Breese, IL 62230-3510 | 2011-01-24 |
| 1174732945 | Douglas M. Kuhl | Pediatrics | 9401 Holy Cross Ln, Suite 112b, Breese, IL 62230-3510 | 2007-05-21 |
| 1477618734 | Fred Charles Boch | Social Worker | 9401 Holy Cross Ln, Suite 112, Breese, IL 62230-3510 | 2006-12-27 |
| 1013027945 | Roch Andre Lefebvre | Family Medicine | 9401 Holy Cross Ln, Suite 112, Breese, IL 62230-3510 | 2006-08-30 |
| 1326158254 | Jonathan Vaughn Osborn | Family Medicine | 9401 Holy Cross Ln, Suite 112, Breese, IL 62230-3510 | 2006-08-30 |
| 1740399674 | Timothy Manson Beaty | Family Medicine | 9401 Holy Cross Ln, Suite 112, Breese, IL 62230-3510 | 2006-08-30 |
| 1851401715 | Paula Robin Griffee-wilcox | Physician Assistant | 9401 Holy Cross Ln, Suite 112, Breese, IL 62230-3510 | 2006-08-30 |
| 1265542120 | Amy Kathleen Krause | Physician Assistant | 9401 Holy Cross Ln, Suite 112, Breese, IL 62230-3510 | 2006-08-30 |
| 1811945264 | David L Neighbors | Family Medicine | 9401 Holy Cross Ln, Breese, IL 62230-3510 | 2006-05-05 |
| 1992772289 | David Louis Kee | Podiatrist | 9401 Holy Cross Ln, Suite 115, Breese, IL 62230-3510 | 2006-03-05 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1841738457 | Coping 4 Kids | Social Worker | 900 N Walnut St., Breese, IL 62230 | 2017-02-02 |
| 1528505146 | Danielle Mueller | Licensed Practical Nurse | 604 North Chestnut, Breese, IL 62230 | 2017-01-20 |
| 1104000561 | Competitive Edge Sports Medicine | Family Medicine | 14160 Jamestown Rd, Breese, IL 62230 | 2007-12-20 |
| 1063606978 | Clarkson Optometry Illinois PC | Optometrist | 103 Clintonian Plaza, Breese, IL 62230 | 2007-09-04 |
| 1013002658 | St Josephs Hospital Breese of The Hospital Sisters of The Third Order | Family Medicine | 9401 Holy Cross Lane, Suite 112, Breese, IL 62230 | 2006-10-03 |
| 1730287434 | Breese Dental Group PC. | Dentist | 9437 Holy Cross Ln., Breese, IL 62230 | 2006-09-20 |
| 1144328832 | Joe Cao Truong | Dentist | 9437 Holy Cross Lane, Breese, IL 62230 | 2006-09-20 |
| 1356391155 | Timothy H Droege | Dentist | 111 North Main, Breese, IL 62230 | 2006-05-11 |
| 1346206042 | Thomas B Doyle | Radiology | 9515 Holy Cross Lane, Breese, IL 62230 | 2006-04-22 |
| 1346730561 | Amanda Walden | Nurse Practitioner | 9401 Holy Cross Ln Ste 112, Breese, IL 62230 | 2018-05-14 |
| Find all providers in zip 62230 | ||||
| Taxonomy Code | 208600000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Surgery |
| A general surgeon has expertise related to the diagnosis - preoperative, operative and postoperative management - and management of complications of surgical conditions in the following areas: alimentary tract; abdomen; breast, skin and soft tissue; endocrine system; head and neck surgery; pediatric surgery; surgical critical care; surgical oncology; trauma and burns; and vascular surgery. General surgeons increasingly provide care through the use of minimally invasive and endoscopic techniques. Many general surgeons also possess expertise in transplantation surgery, plastic surgery and cardiothoracic surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added; 7/1/2011: modified source] - Additional Resources: American Board of Surgery, 2007. http://www.absurgery.org/. American Osteopathic Board of Surgery, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Surgery. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Surgery. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962660753 | Ulunna Kechinyere Macbean | Surgery | 9515 Holy Cross Ln Ste 175, Breese, IL 62230-3618 | 2008-05-28 |
| 1104143510 | Osman Salih Mahdi Babikir | Surgery | 9515 Holy Cross Ln Ste 175, Breese, IL 62230-3618 | 2010-04-24 |
| 1629016753 | Timothy Mark Ruff | Surgery | 9409 Holy Cross Ln, Breese, IL 62230-3510 | 2006-06-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003430166 | Conlan Joseph Pierce | Surgery | 601 W Park St, Urbana, IL 61801 | 2020-06-04 |
| 1376167809 | Francesco Bajani | Surgery | 664 N Dearborn St Apt 2f, Chicago, IL 60654-3848 | 2020-06-01 |
| 1972123099 | Andrea Liu | Surgery | 5841 S Maryland Ave Mc6040, Chicago, IL 60637-1443 | 2020-04-18 |
| 1750917183 | Alberto Maria Fratti | Surgery | 901 S Ashland Ave Apt 711, Chicago, IL 60607-4088 | 2020-03-17 |
| 1841845047 | Barijuve Surgical LLC | Surgery | 380 E Northwest Hwy Ste 200, Des Plaines, IL 60016-2274 | 2019-08-05 |
| 1164081782 | Sean Park | Surgery | 1739 Tudor Ln Unit 308, Northbrook, IL 60062-3778 | 2019-06-07 |
| 1376014175 | Edwardsville Physicians Group LLC | Surgery | 441 South State Route 157 Suite 102, Edwardsville, IL 62025-4012 | 2018-12-06 |
| 1316421324 | Erica Lester | Surgery | John H Stroger, 1969 Ogden Ave, Chicago, IL 60612 | 2018-09-17 |
| 1023513389 | Crystal Siyu Zhang | Surgery | 2160 S 1st Ave Bldg 3210, Maywood, IL 60153 | 2018-03-28 |
| 1376047381 | Richard Lawrence Nelson | Surgery | 1603 W. Taylor St., Room 983, Chicago, IL 60612-4394 | 2018-03-23 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.