Bloomington Dermatology Clinic

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

01042083A Issued in IN

Legal business name

BLOOMINGTON DERMATOLOGY CLINIC

Practice address

2001 E 3Rd St
Bloomington, IN 47401-7890

Phone

(812) 333-0398

Fax

(812) 333-0698

NPI assigned

Sep 21, 2006

Organization subpart

No

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

Authorized official

Name

Scott M Wilhelmus, M.D.NPI 1346246527

Title

C.E.O.

Phone

(812) 333-0398

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Scott Michael Wilhelmus, M.D.

  • Dermatology Physician
  • Jasper, IN
  • NPI 1346246527
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158796800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1590019200000",
    "number": "1003914920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2001 E 3RD ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474017890",
            "telephone_number": "812-333-0398",
            "fax_number": "812-333-0698"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 E 3RD ST",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474017890",
            "telephone_number": "812-333-0398",
            "fax_number": "812-333-0698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLOOMINGTON DERMATOLOGY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-21",
        "last_updated": "2020-05-21",
        "status": "A",
        "authorized_official_last_name": "WILHELMUS",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "C.E.O.",
        "authorized_official_telephone_number": "812-333-0398",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": "IN",
            "license": "01042083A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000090314",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOCIAL SECURITY NUMBER",
            "identifier": "$$$$$$$$$",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Bloomington, IN
• Providers in Bloomington, IN by specialty
• Dermatology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.