DERMATOLOGY AND SKIN CANCER CENTER
NPI 1093596652
Dermatology in Bloomington, IL
NPI Status: Active since October 10, 2023
Contact Information
3302 GERIG DR STE 100
BLOOMINGTON, IL
ZIP 61704
Phone: (309) 533-7070
Fax: (855) 710-6552
- Organization
- Dermatology
- Accepts Insurance
- CLIA Number: 14D2292136
- CLIA Cert. Type: Physician Office
- CLIA Exp. Date: 12-22-2026
About DERMATOLOGY AND SKIN CANCER CENTER
This page provides the complete NPI Profile along with additional information for Dermatology And Skin Cancer Center, a provider established in Bloomington, Illinois operating as a Dermatology. The healthcare provider is registered in the NPI registry with number 1093596652 assigned on October 2023. The practitioner's primary taxonomy code is 207N00000X. The provider is registered as an organization and their NPI record was last updated one year ago. Dermatology And Skin Cancer Center operates as a multi-specialty business group with one or more individual providers who practice different areas of specialization. The authorized official of this NPI record is Adrienne Schupbach Md (Md/practice Owner)
- NPI
- 1093596652
- Provider Name
- DERMATOLOGY AND SKIN CANCER CENTER
- Entity Type
- Organization
- Location Address
- 3302 GERIG DR STE 100 BLOOMINGTON, IL 61704
- Location Phone
- (309) 533-7070
- Location Fax
- (855) 710-6552
- Mailing Address
- 3302 GERIG DR STE 100 BLOOMINGTON, IL 61704
- Mailing Phone
- (309) 533-7070
- Mailing Fax
- (855) 710-6552
- Is Sole Proprietor?
- No
- Is Organization Subpart?
- No
- Enumeration Date
- 10-10-2023
- Last Update Date
- 12-17-2024
- Code Navigator
A dermatologist like Dermatology And Skin Cancer Center is a medical specialty involving the management of skin conditions and diseases. Dermatologists diagnose some sexually transmitted diseases, warts, cancer, acne, dermatitis and may offer cosmetic treatments, and therapies that reduce age spots and wrinkles.
Location Map
Secondary Locations
- 2011 Rock St
Peru, IL 61354
(815) 410-4555 - 1508 W Reynolds St
Pontiac, IL 61764
(309) 533-7070
Specialty - Primary Taxonomy
The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.
- Classification
Dermatology
- Taxonomy Code
- 207N00000X
- Type
- Allopathic & Osteopathic Physicians
- Taxonomy Description
- A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.
Secondary Taxonomies
The provider has reported to the NPI enumerator additional taxonomy codes. Multiple taxonomy codes may represent subspecialties or other areas of specialization the provider maybe licensed to practice.
| No. | Taxonomy Code | Type | Classification / Specialization |
License No. (State) |
|---|---|---|---|---|
| 1 | 207ND0101X | Allopathic & Osteopathic Physicians | Dermatology |
Group Taxonomy 193200000X MULTI-SPECIALTY GROUP
This provider is a business group of one or more individual practitioners, who practice with different areas of specialization.
Insurance Plans Accepted
According to publicly available information the provider might be accepting the following health plans from these health insurance companies:
- Bronze 1 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay - HMO
- Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
- Bronze 4 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision - HMO
- Bronze S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
- Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
- Gold 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision - HMO
- Gold 3 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay - HMO
- Gold 3 Advanced: Aetna network + $0 MinuteClinic + Adult Dental + Vision + Rx Copay - HMO
- Gold S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay - HMO
- Silver 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
- Silver 10 Advanced: $0 PCP + Aetna network + $0 MinuteClinic + Adult Dental + Vision - HMO
- Silver 5 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care + Rx Copay - HMO
- Silver 5 Advanced: Aetna network + $0 MinuteClinic + Adult Dental + Vision + Rx Copay - HMO
- Silver S: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Primary Care - HMO
- Blue Choice Preferred Bronze PPO? 201 - PPO
- Blue Choice Preferred Bronze PPO? 701 - PPO
- Blue Choice Preferred Bronze PPO? Standard - Select Rx Copays - PPO
- Blue Choice Preferred Gold PPO? 204 - PPO
- Blue Choice Preferred Gold PPO? 901 - PPO
- Blue Choice Preferred Gold PPO? Standard - Rx Copays - PPO
- Blue Choice Preferred Security PPO? 200 - PPO
- Blue Choice Preferred Silver PPO? 203 - PPO
- Blue Choice Preferred Silver PPO? 801 - PPO
- Blue Choice Preferred Silver PPO? Standard - Select Rx Copays - PPO
*Please verify directly with this provider to make sure your insurance plan is currently accepted.
CLIA Information
The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:
- CLIA Number
- 14D2292136
- Facility Type
- Physician Office
- Certificate Effective Date
- December 23, 2024
- Certificate Expiration Date
- December 22, 2026
- Laboratory Director
- ADRIENNE M. SCHUPBACH
- Certificate Type
- Certificate of Compliance
- Certificate Type Description
- This CLIA certificate is issued to Dermatology And Skin Cancer Center after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing.
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NPI Validation Check Digit Calculation
The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.
| Start with the original NPI number, the last digit is the check digit and is not used in the calculation. | |||||||||
| 1 | 0 | 9 | 3 | 5 | 9 | 6 | 6 | 5 | 2 |
| Step 1: Double the value of the alternate digits, beginning with the rightmost digit. | |||||||||
| 2 | 0 | 18 | 3 | 10 | 9 | 12 | 6 | 10 | |
| Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24. | |||||||||
| 2 + 0 + 1 + 8 + 3 + 1 + 0 + 9 + 1 + 2 + 6 + 1 + 0 + 24 = 58 | |||||||||
| Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit. | |||||||||
| 60 - 58 = 2 | 2 | ||||||||
The NPI number 1093596652 is valid because the calculated check digit 2 using the Luhn validation algorithm matches the last digit of the original NPI number.
Other Providers at the Same Location
The following 2 providers are registered at the same or nearby location.
| NPI | Name / Type | Taxonomy | Address |
|---|---|---|---|
| 1922619535 | HANNAH BETHANY ATKINS PA-C Individual | Physician Assistant | 3302 GERIG DR STE 100 BLOOMINGTON, IL 61704 (309) 533-7070 |
| 1538230990 | JOANNE M LAROW DO Individual | Dermatology (MOHS-Micrographic Surgery) | 3302 GERIG DR STE 100 BLOOMINGTON, IL 61704 (309) 533-7070 |
Frequently Asked Questions
The NPI number assigned to this healthcare provider is 1093596652, enumerated in the NPI registry as an "organization" on October 10, 2023
The provider is located at 3302 Gerig Dr Ste 100 Bloomington, Il 61704 and the phone number is (309) 533-7070
This medical organization specializes in Dermatology with taxonomy code 207N00000X
The provider might be accepting Accepts: Aetna CVS Health and Blue Cross and Blue Shield of. Please consult your insurance carrier or call the provider to make sure your health plan is currently accepted.
The provider's CLIA number is 14D2292136 for a "physician office" facility with a CLIA Certificate of Compliance. This CLIA certificate is issued after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements. This type of certificate is issued to laboratories that perform nonwaived (moderate and/or high complexity) testing..
This NPI record was last updated on October 10, 2023. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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