NPIMap

Individual provider Active NPI

Moriah Bang, D.O.

  • Family Medicine Physician
  • Crystal Lake, IL
National Provider Identifier
1750393310
Registry record updated Feb 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036115884 Issued in IL
Practice address
525 E Congress Pkwy
Suite 250
Crystal Lake, IL 60014-6245
Phone
(815) 479-7490
Fax
(815) 455-2654
NPI assigned
Aug 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036115884 IL Primary

Addresses

Primary practice location

525 E Congress Pkwy
Suite 250
Crystal Lake, IL 60014-6245

Mailing address

29373 Network PL
Chicago, IL 60673-6245
Phone (847) 390-5900

Other identifiers 2

IdentifierTypeStateIssuer
43536000MedicaidWI
036115884MedicaidIL

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address mbang205376@direct.myadvocateaurora.org Direct
FHIR URL https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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
I20061010000076 IL Practitioner - Family Practice 4183620453 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Midwestern University, Chicago College of Osteopathic Med, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

214 McHenry Rd
Buffalo Grove, IL 60089-6748
Phone (847) 459-1160

525 E Congress Pkwy
Crystal Lake, IL 60014-6258

633 Ridgeview Dr
McHenry, IL 60050-7012
Phone (815) 344-0621

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Advocate Health and Hospitals Corporation CurrentSince Sep 14, 2015 Accepting new patients
Advocate Health and Hospitals Corporation Current Accepting new patients
Advocate Health & Hospitals Corporation CurrentSince Sep 14, 2015 Accepting new patients

Locations

214 McHenry Rd
Buffalo Grove, IL 60089
Phone (847) 459-1160

29373 Network Pl
Chicago, IL 60673

525 E Congress Pkwy
Ste 250
Crystal Lake, IL 60014
Phone (815) 455-7200

525 E Congress Pkwy
Ste 350
Crystal Lake, IL 60014
Phone (815) 455-7400

Interoperability endpoints

  • Direct secure messaging: mbang205376@direct.myadvocateaurora.org

Organizations & group practices 3

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.

Hospital & facility affiliations 7

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

NPI Registry JSON

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

{
    "created_epoch": "1155340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675296000000",
    "number": "1750393310",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "29373 NETWORK PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606736245",
            "telephone_number": "847-390-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "525 E CONGRESS PKWY",
            "address_2": "SUITE 250",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600146245",
            "telephone_number": "815-479-7490",
            "fax_number": "815-455-2654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BANG",
        "first_name": "MORIAH",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-12",
        "last_updated": "2023-02-02",
        "certification_date": "2023-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036115884",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43536000",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036115884",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mbang205376@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "525 E Congress Pkwy",
            "address_2": "Suite 250",
            "city": "Crystal Lake",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600146245",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "525 E Congress Pkwy",
            "address_2": "Suite 250",
            "city": "Crystal Lake",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600146245",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Crystal Lake, IL

Sources for this page

Verify at the official NPI Registry.