DR. KELLY GOLDSMITH (NPI# 1306468822) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306468822 |
| Entity Type | Individual |
| Full Name | DR. KELLY GOLDSMITH |
| Other Name | KELLY PAULS |
| Credential | DO |
| Practice Address |
1 Illini Dr Peoria IL 61605-2576 |
| Mailing Address |
9505 E 203rd St Peculiar MO 64078-8792 |
| Practice Telephone | 8584447309 |
| Mailing Telephone | 8584447309 |
| Enumeration Date | 2020-05-07 |
| Last Update Date | 2020-05-07 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | 125.076125 | IL | Student, Health Care |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871512467 | Kelly A Goldsmith | Pediatrics | 3401 Civic Center Blvd, Children's Hospital of Philadelphia, Philadelphia, PA 19104-4319 | 2006-07-18 |
| Street Address |
1 ILLINI DR |
| City | PEORIA |
| State | IL |
| Zip Code | 61605-2576 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134198856 | Richard Horndasch | Pediatrics | 1 Illini Dr, Medical Service Plan, Peoria, IL 61605-2576 | 2006-03-15 |
| 1063047108 | George Elliot Tsourdinis | Student in an Organized Health Care Education/Training Program | 1 Illini Dr, Peoria, IL 61605-2576 | 2020-03-09 |
| 1912532110 | Alexandria Patricia Weston | Student in an Organized Health Care Education/Training Program | 1 Illini Dr, Peoria, IL 61605-2576 | 2020-03-08 |
| 1659928208 | Robert George | Student in an Organized Health Care Education/Training Program | 1 Illini Dr, Peoria, IL 61605-2576 | 2019-08-19 |
| 1649838327 | Megan Michelle Mccollum | Student in an Organized Health Care Education/Training Program | 1 Illini Dr, Peoria, IL 61605-2576 | 2019-05-29 |
| 1033774104 | Valerie Jaroenpuntaruk | Student in an Organized Health Care Education/Training Program | 1 Illini Dr, Peoria, IL 61605-2576 | 2019-05-04 |
| 1588186944 | Jeanna Rich | Dietitian, Registered | 1 Illini Dr, Peoria, IL 61605-2576 | 2017-07-07 |
| 1932638186 | Jonathan George Bardahl | Pediatrics | 1 Illini Dr, Peoria, IL 61605-2576 | 2017-06-09 |
| 1467980011 | Yuliya Belopolsky | Internal Medicine | 1 Illini Dr, Peoria, IL 61605-2576 | 2017-05-26 |
| 1821342973 | Roger William Geiss | Pathology | 1 Illini Dr, Department of Pathology, Peoria, IL 61605-2576 | 2012-10-27 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1386131878 | Nicholas Anthony Helling | Physical Therapist | 518 W Romero B Garret Ave, Poeria, IL 61605 | 2018-04-19 |
| 1891241022 | Peoria Slf Lp | Assisted Living Facility | 518 West Romeo B. Garrett Avenue, Peoria, IL 61605 | 2016-08-28 |
| 1932479664 | Michelle L Whitelow | Nurse Practitioner | 711 W John Gwynn Jr. Avenue, Peoria, IL 61605 | 2012-01-11 |
| 1982852877 | Jason M Anane-sefah | Orthopaedic Surgery | 303 North Kumpf Boulevard, Peoria, IL 61605 | 2008-09-04 |
| 1902098908 | Calvary Elderly Home Help Program | Home Health | 1709 W Lincoln Ave, Peoria, IL 61605 | 2007-08-14 |
| 1023104437 | Thomas Anderson | Optometrist | 710 W Third Avenue, Peoria, IL 61605 | 2006-10-04 |
| 1841382298 | Devashish Agarwal | Family Medicine | 1701 W. Garden Street, Peoria, IL 61605 | 2006-09-29 |
| 1497763197 | Larry T Rolle | Pharmacist | 411 Martin Luther King Dr., Peoria, IL 61605 | 2006-08-04 |
| 1568404762 | Joseph P Kelly Iv | Physical Therapist | 303 N. Kumpf Blvd, Peoria, IL 61605 | 2006-06-12 |
| 1003861634 | Patrick William Elwood | Neurological Surgery | 719 N William Kumpf Blvd, Suite 100, Peoria, IL 61605 | 2006-05-23 |
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| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821609751 | Amanda Ferreira | Student in an Organized Health Care Education/Training Program | 7421 W Shangri La Rd, Peoria, AZ 85345-5811 | 2020-08-13 |
| 1699396838 | Ashif Khaled Molla | Student in an Organized Health Care Education/Training Program | Osf St Francis Medical Center 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 | 2020-04-28 |
| 1437779063 | Mena Henien | Student in an Organized Health Care Education/Training Program | 530 Ne Glen Oak Ave Bldg 5676, Peoria, IL 61637-0001 | 2020-04-23 |
| 1306465893 | Sarath Kumar Jaganathan Jaishankar | Student in an Organized Health Care Education/Training Program | 530 Ne Glenn Oak Avenue, Peoria, IL 61637-0001 | 2020-04-14 |
| 1952920522 | Phu Si Huynh | Student in an Organized Health Care Education/Training Program | 331 Fulton St Apt 302, Peoria, IL 61602-1436 | 2020-04-13 |
| 1730736604 | Gabriela C Isenia | Student in an Organized Health Care Education/Training Program | 9031 W Tonopah Dr, Peoria, AZ 85382-6445 | 2019-08-24 |
| 1831751643 | Noreen Khan | Student in an Organized Health Care Education/Training Program | 1501 W Coneflower Dr Apt 2212, Peoria, IL 61615-7465 | 2019-07-01 |
| 1174184527 | Manisha Tharoor | Student in an Organized Health Care Education/Training Program | 530 N.e Glen Oak Ave, Peoria, IL 61637 | 2019-06-26 |
| 1609436724 | Sriviji Senthil Kumaran | Student in an Organized Health Care Education/Training Program | 530. N.e Glen Oak Ave., Peoria, IL 61637 | 2019-06-20 |
| 1780240929 | Abuzar Ali Asif | Student in an Organized Health Care Education/Training Program | 530 N. E. Glen Oak Ave., Peoria, IL 61637 | 2019-05-14 |
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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.