Active NPI
Dermatology Specialists of Illinois, LTD
- Dermatology Physician
- Algonquin, IL
National Provider Identifier
1144610080
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dermatology Physician
- Legal business name
- DERMATOLOGY SPECIALISTS OF ILLINOIS, LTD
- Practice address
- 2430 Esplanade Drive
Suite B
Algonquin, IL 60102 - Phone
- (212) 627-6515
- NPI assigned
- Jan 30, 2015
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Vikram Khanna
- Title
- President
- Phone
- (847) 528-1177
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dermatology Physician | 207N00000X | Primary | ||
| Non-Pharmacy Dispensing Site | 332900000X |
Addresses
Primary practice location
2430 Esplanade Drive
Suite B
Algonquin, IL 60102
Mailing address
2430 Esplanade Drive
Suite B
Algonquin, IL 60102
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093219610 | Medicaid | IL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150608000017 | IL | Part B Supplier - Clinic/Group Practice | 7517288236 |
Receives reassigned benefits from 15 practitioners Practice locations: Algonquin, IL; Huntley, IL; Lake Barrington, IL; Woodstock, IL |
National Provider Directory
National Provider DirectoryLocations
12525 Regency Pkwy
Huntley, IL 60142
Phone (815) 356-0500
2400 Lake Shore Dr
Woodstock, IL 60098
2454 Lake Shore Dr
Woodstock, IL 60098
Phone (847) 458-7546
Practitioners & affiliated clinicians
Practitioners 17
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1422576000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1687737600000",
"number": "1144610080",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2430 ESPLANADE DRIVE",
"address_2": "SUITE B",
"city": "ALGONQUIN",
"state": "IL",
"postal_code": "60102"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2430 ESPLANADE DRIVE",
"address_2": "SUITE B",
"city": "ALGONQUIN",
"state": "IL",
"postal_code": "60102",
"telephone_number": "212-627-6515"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "DERMATOLOGY SPECIALISTS OF ILLINOIS, LTD",
"organizational_subpart": "NO",
"enumeration_date": "2015-01-30",
"last_updated": "2023-06-26",
"certification_date": "2023-06-26",
"status": "A",
"authorized_official_last_name": "KHANNA",
"authorized_official_first_name": "VIKRAM",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "847-528-1177"
},
"taxonomies": [
{
"code": "207N00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Dermatology",
"state": null,
"license": null,
"primary": true
},
{
"code": "332900000X",
"taxonomy_group": "",
"desc": "Non-Pharmacy Dispensing Site",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1093219610",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Algonquin, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.