NPIMap

Organization Active NPI

Premier Medical Group, LLC

Doing business as Drs. Kulb, Chalian and Leak Urology

  • Urology Physician
  • Bloomington, IL
National Provider Identifier
1427357227
Registry record updated Mar 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
PREMIER MEDICAL GROUP, LLC
Doing business as
Drs. Kulb, Chalian and Leak Urology
Practice address
1401 Eastland Dr Ste B
Bloomington, IL 61701-3514
Phone
(309) 663-9424
Fax
(309) 663-6350
NPI assigned
Mar 18, 2011
Last updated
Mar 18, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 18, 2011

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

Authorized official

Name
John Hesse
Title
Executive Director
Phone
(309) 662-6200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X Primary

Addresses

Primary practice location

1401 Eastland Dr Ste B
Bloomington, IL 61701-3514

Mailing address

1401 Eastland Dr Ste B
Bloomington, IL 61701-3514
Phone (309) 663-9424

Other names 1

  • Drs. Kulb, Chalian and Leak Urology Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20110714000207 IL DME Supplier - Physician - Urology 5991989477 Practice locations: Bloomington, IL

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Premier Medical Group LLC12 organizations share this tax ID, including this one

Other organizations with this tax ID 11

Organizations that report the same tax identification number in the National Provider Directory.

Locations

1300 Franklin Ave
Ste 270
Normal, IL 61761
Phone (309) 454-1074

1537 Fort Jesse Rd
Ste A
Normal, IL 61761
Phone (309) 212-2002

Practitioners & affiliated clinicians

Practitioners 11

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.

NPI Registry JSON

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

{
    "created_epoch": "1300406400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300406400000",
    "number": "1427357227",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 EASTLAND DR STE B",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013514",
            "telephone_number": "309-663-9424",
            "fax_number": "309-663-6350"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1401 EASTLAND DR STE B",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013514",
            "telephone_number": "309-663-9424",
            "fax_number": "309-663-6350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER MEDICAL GROUP, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-18",
        "last_updated": "2011-03-18",
        "status": "A",
        "authorized_official_last_name": "HESSE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "309-662-6200"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Drs. Kulb, Chalian and Leak Urology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bloomington, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 18, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.