NPIMap

Individual provider Active NPI

Willett Pang, MD

  • Diagnostic Radiology Physician
  • Springfield, IL
National Provider Identifier
1407813637
Registry record updated Aug 12, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
32680 Issued in WI
Practice address
3050 Montvale Dr Ste a
Springfield, IL 62704-6924
Phone
(217) 726-8096
NPI assigned
May 1, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 12, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 32680 WI Primary

Addresses

Primary practice location

3050 Montvale Dr Ste a
Springfield, IL 62704-6924

Mailing address

2040 W Iles Ave Ste C
Springfield, IL 62704-4183
Phone (217) 789-0668

Other identifiers 1

IdentifierTypeStateIssuer
31753300MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040421000064 WI Practitioner - Diagnostic Radiology 9436145018 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Tulane University School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
The Duluth Clinic LTDGroup PAC ID 2567374283, 1,135 clinicians
St Marys Hospital of SuperiorGroup PAC ID 8628964228, 96 clinicians

Practice addresses (Care Compare)

15495 County Rd B
Hayward, WI 54843-3438
Phone (715) 634-2641

1615 Maple LN
Suite 1
Ashland, WI 54806-3630
Phone (715) 685-7500

3500 Tower Ave
Superior, WI 54880-4491
Phone (715) 392-8281

3500 Tower Ave
Superior, WI 54880-5335
Phone (715) 395-5454

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
St. Mary'S Hospital of Superior CurrentSince Oct 1, 2018 Accepting new patients
St. Mary'S Hospital of Superior CurrentSince Oct 1, 2018 Accepting new patients
The Duluth Clinic, LTD Current Accepting new patients
The Duluth Clinic, LTD. CurrentSince Mar 6, 2017 Accepting new patients
St. Mary'S Duluth Clinic Health System Current Accepting new patients
Prairie Du Chien Memorial Hospital Assoc Inc CurrentSince Feb 6, 2017 Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients
Dean Health Systems, Inc, Past Accepting new patients
Radiology Associates of the Fox Valley, SC Diagnostic Radiology Past Accepting new patients
The Duluth Clinic, LTD Past Accepting new patients
Great Lakes Radiologists SC Diagnostic Radiology Past Accepting new patients
Aurora Medical Group, Inc. Past Accepting new patients

Locations

15495 County Road B
Hayward, WI 54843
Phone (715) 634-2641

37868 US Highway 18
Prairie du Chien, WI 53821
Phone (608) 357-2000

3500 Tower Ave
Ste 1
Superior, WI 54880
Phone (715) 395-5457

3500 Tower Ave
Superior, WI 54880
Phone (715) 392-8281

Interoperability endpoints

  • Direct secure messaging: wpang281593@direct.myadvocateaurora.org
  • Direct secure messaging: wpang734260@direct.emplifyhealth.org

Organizations & group practices 13

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.

View all 13

Hospital & facility affiliations 36

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439337600000",
    "number": "1407813637",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2040 W ILES AVE STE C",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627044183",
            "telephone_number": "217-789-0668"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3050 MONTVALE DR STE A",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627046924",
            "telephone_number": "217-726-8096"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PANG",
        "first_name": "WILLETT",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-01",
        "last_updated": "2015-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": "32680",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31753300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, IL

Sources for this page

Verify at the official NPI Registry.