Individual provider Active NPI

Thomas B Kulb, M.D.,

  • Urology Physician
  • Bloomington, IL
National Provider Identifier
1770511594
Registry record updated Sep 13, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Practice address
1401 Eastland Dr
Suite B
Bloomington, IL 61701-3514
Phone
(309) 663-9424
Fax
(309) 663-6350
NPI assigned
Jun 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X IL Primary

Addresses

Primary practice location

1401 Eastland Dr
Suite B
Bloomington, IL 61701-3514

Mailing address

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

Other identifiers 2

IdentifierTypeStateIssuer
0723870001OtherILDME PROVIDER NUMBER
5732045OtherILBC BS PROVIDER NUMBER

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036074999ILMDUrology Physician

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1151539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1189641600000",
    "number": "1770511594",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1401 EASTLAND DR",
            "address_2": "SUITE 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",
            "address_2": "SUITE B",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617013514",
            "telephone_number": "309-663-9424",
            "fax_number": "309-663-6350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KULB",
        "first_name": "THOMAS",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "M.D.,",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-29",
        "last_updated": "2007-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DME PROVIDER NUMBER",
            "identifier": "0723870001",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS PROVIDER NUMBER",
            "identifier": "5732045",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Sep 13, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.