Dermatology and Skin Cancer Center

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

DERMATOLOGY AND SKIN CANCER CENTER

Practice address

3302 Gerig Dr Ste 100
Bloomington, IL 61704-6343

Phone

(309) 533-7070

Fax

(855) 710-6552

NPI assigned

Oct 10, 2023

Last updated

Dec 17, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Adrienne Schupbach, MDNPI 1740415777

Title

MD/Practice Owner

Phone

(309) 533-7070

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

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

CLIA laboratory certificates

Locations

Practitioners 14

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Adrienne Schupbach, M.D.

  • Dermatology Physician
  • Bloomington, IL
  • NPI 1740415777
  Medicare reassignment Care Compare group NPD Authorized official
• Kelsey Eddington, PA-C

  • Physician Assistant
  • Bloomington, IL
  • NPI 1841073137
  Medicare reassignment Care Compare group NPD
• Joanne M Larow, DO

  • MOHS-Micrographic Surgery Physician
  • Bloomington, IL
  • NPI 1538230990

  Single Specialty

  Medicare reassignment Care Compare group NPD
• Shawn Barrett Jackson, M,D,

  • Anatomic Pathology & Clinical Pathology Physician
  • Springfield, MO
  • NPI 1730258708

  IL

  Medicare reassignment Care Compare group NPD
• Douglas Michael Leone, M.D.

  • Dermatology Physician
  • Branson, MO
  • NPI 1255523296

  IL

  Medicare reassignment Care Compare group NPD
• Ryan Michael Marlett

  • Physician Assistant
  • Branson, MO
  • NPI 1952058992

  IL

  Medicare reassignment Care Compare group
• Hannah Bethany Atkins, PA-C

  • Physician Assistant
  • Bloomington, IL
  • NPI 1922619535
  Medicare reassignment
• Kathryn Sue Bohn, M.D.

  • Phlebology Physician
  • Bloomington, IL
  • NPI 1194751156
  NPD
• Richard Castillo, M.D.

  • Phlebology Physician
  • Bloomington, IL
  • NPI 1649207960
  NPD
• Mary Terese Couture-Ginnetti, DO

  • Emergency Medicine Physician
  • Urbana, IL
  • NPI 1962064782
  NPD
• Gerardo A Grieco, M.D.

  • Surgery Physician
  • Normal, IL
  • NPI 1245242403
  NPD
• Thomas Edwin Nielsen, M.D.

  • Phlebology Physician
  • Bloomington, IL
  • NPI 1871521757
  NPD

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

{
    "created_epoch": "1696896000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1734393600000",
    "number": "1093596652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3302 GERIG DR STE 100",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617046343",
            "telephone_number": "309-533-7070",
            "fax_number": "855-710-6552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3302 GERIG DR STE 100",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617046343",
            "telephone_number": "309-533-7070",
            "fax_number": "855-710-6552"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2011 Rock St",
            "address_purpose": "LOCATION",
            "city": "Peru",
            "state": "IL",
            "postal_code": "613541385",
            "country_code": "US",
            "telephone_number": "815-410-4555",
            "fax_number": "855-710-6552",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1508 W Reynolds St",
            "address_purpose": "LOCATION",
            "city": "Pontiac",
            "state": "IL",
            "postal_code": "617642811",
            "country_code": "US",
            "telephone_number": "309-533-7070",
            "fax_number": "855-710-6552",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "DERMATOLOGY AND SKIN CANCER CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-10-10",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A",
        "authorized_official_last_name": "SCHUPBACH",
        "authorized_official_first_name": "ADRIENNE",
        "authorized_official_title_or_position": "MD/PRACTICE OWNER",
        "authorized_official_telephone_number": "309-533-7070",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dental Professionals of Illinois, P.C. (Hershey Plaza Dental Care)
• Dental Professionals of Illinois, P.C. (Bloomington Smile Center)
• John Scott Denton, M.D.
• Julia Deredowski
• Dermatology and Mohs Surgery Institute, LTD.
• Shivani Chetan Desai, DMD
• Debra Descarpentrie, LPC
• Hatem Desoky, M.D.
• Hannah Deterding
• Angie Detwiler, CNM

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; 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.