Benjamin J Leak (NPI# 1043248867, PAC ID# 5698763811) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is UROLOGY.
| Nation Provider ID (NPI) | 1043248867 |
| PAC ID by PECOS | 5698763811 |
| Professional Enrollment ID | I20040505000492 |
| Full Name | Benjamin J Leak |
| Organization Legal Name | PREMIER MEDICAL GROUP, LLC |
| Address |
1401 Eastland Dr B Bloomington IL 61701-3553 |
| Phone Number | 3096639424 |
| Gender | M |
| Credential | MD |
| Medical School | UNIVERSITY OF ILLINOIS AT CHICAGO HEALTH SCIENCE CENTER |
| Graduation Year | 2003 |
| Primary Specialty | UROLOGY |
| Group Practice PAC ID | 5991989477 |
| Number of Group Practice Members | 9 |
| Accepts Medicare Assignment | Y |
| Claim Control Number (CCN) | Legal Business Name |
|---|---|
| 140242 | CENTRAL DUPAGE HOSPITAL |
| 140127 | ADVOCATE BROMENN MEDICAL CENTER |
| 140161 | SAINT JAMES HOSPITAL |
| 140162 | ST JOSEPH MEDICAL CENTER |
| 140110 | OTTAWA REGIONAL HOSPITAL DBA OSF SAINT ELIZABETH MDL CTR |
| Address | Phone | Organization |
|---|---|---|
| 1401 Eastland Dr B, Bloomington, IL 61701-3553 | 3096639424 | PREMIER MEDICAL GROUP, LLC |
| Organization Legal Name | PREMIER MEDICAL GROUP, LLC |
| Physicians | 10 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Nancy J Davis | Certified Registered Nurse Anesthetist (crna) | Premier Medical Group, LLC | 2200 Jacobssen Dr, Normal, IL 61761-5516 |
| Stephen S Matter | Gastroenterology | Premier Medical Group, LLC | 1401 Eastland Dr B, Bloomington, IL 61701-3553 |
| Roy G Haynes | Certified Registered Nurse Anesthetist (crna) | Premier Medical Group, LLC | 1401 Eastland Dr B, Bloomington, IL 61701-3553 |
| Renuka A Bhaskar | Pathology | Premier Medical Group, LLC | 1401 Eastland Dr B, Bloomington, IL 61701-3553 |
| Anastasia V Kovalaske | Nurse Practitioner | Premier Medical Group, LLC | 1401 Eastland Dr B, Bloomington, IL 61701-3553 |
| Summer A Hinthorne | Nurse Practitioner | Premier Medical Group, LLC | 1401 Eastland Dr B, Bloomington, IL 61701-3553 |
| Vicken S Chalian | Urology | Premier Medical Group, LLC | 1401 Eastland Dr B, Bloomington, IL 61701-3553 |
| Salvatore Catarinicchia | Urology | Premier Medical Group, LLC | 1401 Eastland Dr B, Bloomington, IL 61701-3553 |
| Thomas B Kulb | Urology | Premier Medical Group, LLC | 1401 Eastland Dr B, Bloomington, IL 61701-3553 |
| Street Address |
1401 EASTLAND DR B |
| City | BLOOMINGTON |
| State | IL |
| Zip | 61701-3553 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Stephen S Matter | Gastroenterology | Premier Medical Group, LLC | 1401 Eastland Dr B, Bloomington, IL 61701-3553 |
| Roy G Haynes | Certified Registered Nurse Anesthetist (crna) | Premier Medical Group, LLC | 1401 Eastland Dr B, Bloomington, IL 61701-3553 |
| Renuka A Bhaskar | Pathology | Premier Medical Group, LLC | 1401 Eastland Dr B, Bloomington, IL 61701-3553 |
| Anastasia V Kovalaske | Nurse Practitioner | Premier Medical Group, LLC | 1401 Eastland Dr B, Bloomington, IL 61701-3553 |
| Summer A Hinthorne | Nurse Practitioner | Premier Medical Group, LLC | 1401 Eastland Dr B, Bloomington, IL 61701-3553 |
| Vicken S Chalian | Urology | Premier Medical Group, LLC | 1401 Eastland Dr B, Bloomington, IL 61701-3553 |
| Salvatore Catarinicchia | Urology | Premier Medical Group, LLC | 1401 Eastland Dr B, Bloomington, IL 61701-3553 |
| Thomas B Kulb | Urology | Premier Medical Group, LLC | 1401 Eastland Dr B, Bloomington, IL 61701-3553 |
| Name | Specialty | Organization | Address |
|---|---|---|---|
| Anthony J Buecker | Emergency Medicine | St. Joseph Medical Center | 2200 W Washington St, Bloomington, IL 61701 |
| Ryan E Newberger | Emergency Medicine | St. Joseph Medical Center | 2200 W Washington St, Bloomington, IL 61701 |
| Kayla S Olesky | Emergency Medicine | St. Joseph Medical Center | 2200 W Washington St, Bloomington, IL 61701 |
| Alex R Yuan | Emergency Medicine | St. Joseph Medical Center | 2200 W Washington St, Bloomington, IL 61701 |
| Tracy Pacini | Nurse Practitioner | Chestnut Health Systems, Inc. | 1003 Martin Luther King Dr, Bloomington, IL 61701-1429 |
| Dean Ryan Mccullough | Clinical Social Worker | Chestnut Health Systems, Inc. | 1003 Martin Luther King Dr, Bloomington, IL 61701-1429 |
| James W Tarasuik Jr. | Nurse Practitioner | Chestnut Health Systems, Inc. | 1003 Martin Luther King Dr, Bloomington, IL 61701-1429 |
| Jenia Rochelle Heavens | Nurse Practitioner | Chestnut Health Systems, Inc. | 1003 Martin Luther King Dr, Bloomington, IL 61701-1429 |
| Paula C Miller | Nurse Practitioner | Chestnut Health Systems, Inc. | 1003 Martin Luther King Dr, Bloomington, IL 61701-1429 |
| Nancy G Duffy | Clinical Social Worker | Chestnut Health Systems, Inc. | 1003 Martin Luther King Dr, Bloomington, IL 61701-1429 |
| Find all physicians in zip 61701 | |||
| City | BLOOMINGTON |
| Zip Code | 61701 |
| Specialty | UROLOGY |
| City + Specialty | BLOOMINGTON + UROLOGY |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS) |
| Jurisdiction | Medicare |
This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.