Taylor Marie Wells, MD

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

0101286334 Issued in VA

Practice address

4909 N Glen Park Place Rd
Peoria, IL 61614-4676

Phone

(309) 712-4193

NPI assigned

Apr 6, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Dermatology

Education

Meharry Medical College School of Medicine, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Soderstrom Dermatology Center S CGroup PAC ID 2062432651, 31 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Soderstrom Dermatology Center S C

  • Dermatology Physician
  • Peoria, IL
  • NPI 1710931670
  Medicare reassignment Care Compare group
• Vitalskin Medical Group Il PLLC

  • Dermatology Physician
  • Mattoon, IL
  • NPI 1063030252
  Medicare reassignment

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

{
    "created_epoch": "1617667200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1761955200000",
    "number": "1013596998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4909 N GLEN PARK PLACE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4909 N GLEN PARK PLACE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144676",
            "telephone_number": "309-712-4193"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLS",
        "first_name": "TAYLOR",
        "middle_name": "MARIE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-04-06",
        "last_updated": "2025-11-01",
        "certification_date": "2025-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "VA",
            "license": "0101286334",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lori Welke, PA-C
• Jeffrey Osborn Wellard
• Tara Wellenreiter
• Naomi Wells, PHARM.D.
• Rachel L Wells, SPEECH/LANG PATH
• Maureen Welty, DNP
• Abigail V. Welu, DO
• Wendy'S Eyeglass Shack, Inc.
• Jamie Wernsman, PH.D.
• Carly Nicole Wertz, CARLY

• Dermatology Physician in Peoria, IL
• Providers in Peoria, IL by specialty
• Dermatology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.