Individual provider Active NPI

Benjamin Gulbrand, MD

  • Surgery Physician
  • Urbana, IL
National Provider Identifier
1770003022
Registry record updated Apr 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
125.071396 Issued in IL
Practice address
611 W Park St
Urbana, IL 61801-2529
Phone
(217) 383-3311
NPI assigned
Jun 27, 2017
Last updated
Apr 12, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 12, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 125.071396 IL Primary

Addresses

Primary practice location

611 W Park St
Urbana, IL 61801-2529

Mailing address

611 W Park St
Urbana, IL 61801-2529

Other identifiers 1

IdentifierTypeStateIssuer
125.071396OtherILTEMPORARY MEDICAL PERMIT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN, IL2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20220924000319 IN Practitioner - General Surgery 2365827540 Reassigns benefits to 1 organization
I20221216002588 IL Practitioner - General Surgery 2365827540 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General Surgery
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Hendricks County HospitalGroup PAC ID 4880505528, 341 clinicians

Practice addresses (Care Compare)

1000 E Main St
Danville, IN 46122-1948

112 Hospital LN
Danville, IN 46122-2600

5492 N Ronald Reagan Pkwy
Suite 130
Brownsburg, IN 46112-5618
Phone (317) 456-9050

8244 E US Hwy 36
Avon, IN 46123-9688

8244 E US Hwy 36 1100
Hendricks Community Hospital
Avon, IN 46123-9627
Phone (317) 272-7500

8244 E US Hwy 36 1320
Avon Internal Medicine
Avon, IN 46123-9688
Phone (317) 272-7519

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125.071396ILMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Carle Health Medical Group CurrentSince Dec 2, 2022 Accepting new patients
Hendricks County Hospital Current Accepting new patients
Hendricks County Hospital CurrentSince Sep 6, 2022 Accepting new patients
Hendricks County Hospital Surgery CurrentSince Sep 6, 2022 Accepting new patients
Hendricks County Hospital Past Accepting new patients
Hendricks County Hospital Past Accepting new patients
Gibson Community Hospital Association Past Accepting new patients
Hendricks County Hospital Past Accepting new patients

Locations

611 W Park St
Urbana, IL 61801
Phone (217) 383-6941

8244 E US Highway 36
Ste 1100
Avon, IN 46123
Phone (317) 272-7500

8244 E US Highway 36
Ste 1340
Avon, IN 46123
Phone (317) 520-5510

112 Hospital Ln
Ste 100
Danville, IN 46122
Phone (317) 745-3740

1100 Southfield Dr
Ste 1370
Plainfield, IN 46168
Phone (317) 837-5570

Interoperability endpoints

  • Direct secure messaging: bbulbrand385621@direct-prd.stelizabeth.com
  • FHIR API: https://sehproxy.stelizabeth.com/arr-fhir/api/FHIR/R4

Organizations & group practices 8

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 1

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": "1498521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681257600000",
    "number": "1770003022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012529"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "611 W PARK ST",
            "city": "URBANA",
            "state": "IL",
            "postal_code": "618012529",
            "telephone_number": "217-383-3311"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GULBRAND",
        "first_name": "BENJAMIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-27",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "IL",
            "license": "125.071396",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TEMPORARY MEDICAL PERMIT",
            "identifier": "125.071396",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Urbana, IL

Sources for this page

Verify at the official NPI Registry.