Bloomington Normal Healthcare, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

7002512 Issued in IL

Legal business name

BLOOMINGTON NORMAL HEALTHCARE, LLC

Practice address

2100 Fort Jesse Rd
Normal, IL 61761-9370

Phone

(309) 834-4000

Fax

(309) 834-4007

NPI assigned

Jul 19, 2005

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Thomas B Kulb, MD

Title

Physician/Owner

Phone

(309) 834-4000

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1083613327. Details of each certification follow.

• CCN 14C0001203 Ambulatory surgical center · Active · Name & address match · Details

Ambulatory surgical center certification: CCN 14C0001203

Legal name

Bloomington-Normal HealthCare Surgery Center

Certification status

Active

Provider type (POS)

Ambulatory surgical center

Participating since

Sep 24, 2025

Last certification

Sep 24, 2025

Ownership / control type

Proprietary

Facility address

2100 Fort Jesse Road
Normal, IL 61761

Listed as

Bloomington Normal Healthcare LLCCCN 14C0001091

Medicare certification status

Terminated Voluntary: merger or closure, Dec 1, 2023From the Provider of Services file

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Member of 2

Organizations this organization is a member of, according to the National Provider Directory.

• Eastland Medical Plaza Surgicenter, LLC

  • Ambulatory Surgical Clinic/Center
  • Bloomington, IL
  • NPI 1699751289

  Member Of

  NPD member
• St Joseph Medical Center

  dba OSF Saint Joseph Medical Center

  • Emergency Medicine Physician
  • Bloomington, IL
  • NPI 1659552859

  Member Of

  NPD member

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Omar S Khokhar, MD

  • Gastroenterology Physician
  • Bloomington, IL
  • NPI 1386865244
  NPD
• Vicken S Chalian, M.D.

  • Urology Physician
  • Bloomington, IL
  • NPI 1871529594
  NPD (past)
• Travis Holt, M.D.

  • Colon & Rectal Surgery Physician
  • Normal, IL
  • NPI 1932320819
  NPD (past)

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

{
    "created_epoch": "1121731200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1083613327",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 FORT JESSE RD",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617619370",
            "telephone_number": "309-834-4000",
            "fax_number": "309-834-4007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 FORT JESSE RD",
            "city": "NORMAL",
            "state": "IL",
            "postal_code": "617619370",
            "telephone_number": "309-834-4000",
            "fax_number": "309-834-4007"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMINGTON NORMAL HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-19",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KULB",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "PHYSICIAN/OWNER",
        "authorized_official_telephone_number": "309-834-4000",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "IL",
            "license": "7002512",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tyler Curtis Bishop, PT, DPT
• Sue Ann Blankenship
• Alexa Blatt, ATC
• Mackenzie Blomquist
• Bloomington Heart Institute
• Bloomington Normal Public Transportation System (Connect Transit)
• Bloomington Perfusionist Inc.
• Bloomington Radiology S C
• Bloomington-Normal Treatment Center, LLC (MedMark Treatment Centers Normal)
• Blue Skies Counseling LLC

• Ambulatory Surgical Clinic/Center in Normal, IL
• Providers in Normal, IL by specialty
• Ambulatory Surgical Clinic/Center in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.