NPIMap

Individual provider Active NPI

Kyle Stang, MD

  • Radiation Oncology Physician
  • Bloomington, IL
National Provider Identifier
1750743134
Registry record updated Jan 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiation Oncology PhysicianTaxonomy code 2085R0001X
License
036157009 Issued in IL
Practice address
2200 E Washington St
Bloomington, IL 61701-4364
Phone
(309) 662-3311
NPI assigned
Mar 24, 2016
Last updated
Jan 22, 2025By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 22, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Radiation Oncology Physician 2085R0001X 036157009 IL Primary

Addresses

Primary practice location

2200 E Washington St
Bloomington, IL 61701-4364

Mailing address

2200 E Washington St
Bloomington, IL 61701-4364

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
I20210714001664 IL Practitioner - Radiation Oncology 1658643317 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Radiation Oncology
Education
Loyola University of Chicago, Stritch School of Medicine, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
St. Joseph Medical CenterGroup PAC ID 8921901620, 2 clinicians
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

210 Saint Joseph Dr
Bloomington, IL 61701-3630
Phone (309) 663-5050

2200 W Washington St
Bloomington, IL 61701
Phone (309) 662-3311

8600 State Route 91
Suite 130
Peoria, IL 61615-7829
Phone (309) 683-5050

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036157009ILMDRadiation Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central PA Pharmacy LLC. Current Accepting new patients
St Joseph Medical Center CurrentSince Jul 1, 2021 Accepting new patients
Bloomington Medical Laboratory Physicians, S.C. Current Accepting new patients
St Joseph Medical Center Current Accepting new patients
Osf Multi-Specialty Group CurrentSince Aug 27, 2025 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
St Joseph Medical Center Past Accepting new patients

Locations

210 Saint Joseph Dr
Bloomington, IL 61701
Phone (309) 663-5050

2200 E Washington St
Bloomington, IL 61701
Phone (309) 661-5111

124 SW Adams St
Peoria, IL 61602
Phone (309) 655-2850

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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": "1458777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737504000000",
    "number": "1750743134",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 E WASHINGTON ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617014364"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 E WASHINGTON ST",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617014364",
            "telephone_number": "309-662-3311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STANG",
        "first_name": "KYLE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2016-03-24",
        "last_updated": "2025-01-22",
        "certification_date": "2025-01-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0001X",
            "taxonomy_group": "",
            "desc": "Radiology, Radiation Oncology",
            "state": "IL",
            "license": "036157009",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Bloomington, IL

Sources for this page

Verify at the official NPI Registry.