Dermatology and Mohs Surgery Institute, Ltd.
NPI 1770828626ActiveOrganization· Specialist· Bloomington, IL
Specialist in Bloomington, Illinois, registered in NPPES in December 2012. The authorized official on file is Jeffrey K. McKenna, Physician Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1770828626 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Dec 4, 2012 |
| Last updated in NPPES | Jul 9, 2026 |
| Certified by provider | Jul 9, 2026 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Specialist Primary | 174400000X | 036.129240 | 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) |
|---|
Other Specialist providers in Bloomington
- 1053506352
- 1881641371
- 1396464657
- 1003900820
- 1700061983
- 1528015013
- 1942268271
- 1891891370
- 1043315021
- 1760423206
- 1942241484
- 1760588248