Central Illinois Dermatology, S.C.
NPI 1548358054ActiveOrganization· Dermatology· Peoria, IL
Dermatology in Peoria, Illinois, registered in NPPES in October 2006. The authorized official on file is Christopher T. Kroodsma, M.D., President. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1548358054 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Oct 10, 2006 |
| Last updated in NPPES | Jul 13, 2010 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Dermatology Primary | 207N00000X | 042004157 | IL |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (IL) |
|---|
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