NPIMap

Organization Active NPI

Forefront Dermatology, S.C.

Doing business as The DERM, A Forefront Dermatology Practice

  • Dermatology Physician
  • Park Ridge, IL
National Provider Identifier
1053994004
Registry record updated Apr 28, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
Legal business name
FOREFRONT DERMATOLOGY, S.C.
Doing business as
The DERM, A Forefront Dermatology Practice
Practice address
2604 Dempster St Ste 101
Park Ridge, IL 60068-8425
Phone
(847) 843-3376
Fax
(847) 998-8631
NPI assigned
Apr 28, 2021
Last updated
Apr 28, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2021

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

Authorized official

Name
Denise L Anger
Title
Sr. Director, Provider Enrollment
Phone
(920) 663-9022

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X NU Primary
Procedural Dermatology Physician 207NS0135X NU
Diagnostic Radiology Physician 2085R0202X NU

Addresses

Primary practice location

2604 Dempster St Ste 101
Park Ridge, IL 60068-8425

Mailing address

801 York St
Manitowoc, WI 54220-4630
Phone (920) 663-9008

Other names 1

  • The DERM, A Forefront Dermatology Practice Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20151130001424 IL Part B Supplier - Clinic/Group Practice 3779471701 Receives reassigned benefits from 51 practitioners
21 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Libertyville, IL; Lincolnshire, IL; Moline, IL; Morris, IL; Naperville, IL; New Lenox, IL; O Fallon, IL; Park Ridge, IL…

Other NPIs on the same Medicare enrollment 21

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

View all 21

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D2155709Derm, a Forefront Dermatology Practice, the2604 Dempster St - Ste 101, Park Ridge, IL 60068Certificate of waiverOct 2, 2026

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1619568000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1619568000000",
    "number": "1053994004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "801 YORK ST",
            "city": "MANITOWOC",
            "state": "WI",
            "postal_code": "542204630",
            "telephone_number": "920-663-9008",
            "fax_number": "920-684-1439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2604 DEMPSTER ST STE 101",
            "city": "PARK RIDGE",
            "state": "IL",
            "postal_code": "600688425",
            "telephone_number": "847-843-3376",
            "fax_number": "847-998-8631"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FOREFRONT DERMATOLOGY, S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-04-28",
        "last_updated": "2021-04-28",
        "certification_date": "2021-04-28",
        "status": "A",
        "authorized_official_last_name": "ANGER",
        "authorized_official_first_name": "DENISE",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "SR. DIRECTOR, PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "920-663-9022"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The DERM, A Forefront Dermatology Practice",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Park Ridge, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 28, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.