Individual provider Active NPI

Brandon M Bungo, MD

  • Hematology & Oncology Physician
  • Chicago, IL
National Provider Identifier
1871026104
Registry record updated Dec 9, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
036.156133 Issued in IL
Practice address
676 N Saint Clair St Ste 850
Chicago, IL 60611-3124
Phone
(312) 695-6180
Fax
(312) 695-6189
NPI assigned
Apr 4, 2017
Last updated
Dec 9, 2024By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 9, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X NU
Internal Medicine Physician 207R00000X 35.138862 OH
Hematology & Oncology Physician 207RH0003X 036.156133 IL Primary

Addresses

Primary practice location

676 N Saint Clair St Ste 850
Chicago, IL 60611-3124

Mailing address

9500 Euclid Avenue
Cleveland, OH 44195
Phone (216) 444-2200

Other practice location 1

251 E Huron St
Chicago, IL 60611-2908
Phone (330) 671-2291

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20240729001147 IL Practitioner - Hematology/OncologyPractitioner - Internal Medicine 4587932512 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Hematology/OncologyAlso: Internal Medicine
Education
University of Connecticut School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

675 N St Clair
100 Cancer Care Center
Chicago, IL 60611-5970
Phone (312) 695-0990

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.19 of 100Reported as apm
Quality
83.05
Promoting interoperability
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036.156133ILMDHematology & Oncology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northwestern Medical Faculty Foundation CurrentSince Jul 1, 2024 Accepting new patients
Northwestern Medical Faculty Foundation CurrentSince Jul 1, 2024 Accepting new patients
Central Dupage Physician Group Internal Medicine Past Accepting new patients

Locations

Carol Stream, IL 60122
Phone (630) 933-3300

Dept 5777
Carol Stream, IL 60122

251 E Huron St
Chicago, IL 60611

675 N Saint Clair St
Ste 21-100
Chicago, IL 60611

676 N Saint Clair St
Ste 850
Chicago, IL 60611
Phone (312) 695-6180

680 N Lake Shore Dr
Ste 1000
Chicago, IL 60611
Phone (312) 695-4022

660 N Westmoreland Rd
#302
Lake Forest, IL 60045

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, 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": "1491264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1733702400000",
    "number": "1871026104",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9500 EUCLID AVENUE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "44195",
            "telephone_number": "216-444-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "676 N SAINT CLAIR ST STE 850",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606113124",
            "telephone_number": "312-695-6180",
            "fax_number": "312-695-6189"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "251 E Huron St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606112908",
            "country_code": "US",
            "telephone_number": "330-671-2291",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BUNGO",
        "first_name": "BRANDON",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-04-04",
        "last_updated": "2024-12-09",
        "certification_date": "2024-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "OH",
            "license": "35.138862",
            "primary": false
        },
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "IL",
            "license": "036.156133",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.