Southern Illinois Dermatology, PC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

SOUTHERN ILLINOIS DERMATOLOGY, PC

Practice address

220 N Park Ave
Suite 2
Herrin, IL 62948-3150

Phone

(618) 942-3344

Fax

(618) 942-5045

NPI assigned

Jul 10, 2006

Last updated

Jul 29, 2008By 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

Dr. Ted G Van Acker, D. O.NPI 1720025562

Title

President

Phone

(618) 942-3344

Specialties & licenses 1

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 17

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.

• Ted G Van Acker, D.O.

  • Dermatology Physician
  • Herrin, IL
  • NPI 1720025562
  Medicare reassignment Care Compare group NPD Authorized official
• Moses O. Adeyanju, M.D.

  • Anatomic Pathology & Clinical Pathology Physician
  • Carbondale, IL
  • NPI 1306820121
  Medicare reassignment Care Compare group NPD
• Gerri Dyer, NP

  • Nurse Practitioner
  • Herrin, IL
  • NPI 1952328486
  Medicare reassignment Care Compare group NPD
• Constance M Henshaw, FNP-C

  • Family Nurse Practitioner
  • Harrisburg, IL
  • NPI 1760081483
  Medicare reassignment Care Compare group NPD
• Derek G Kenneaster, MD

  • Dermatology Physician
  • Herrin, IL
  • NPI 1457372724
  Medicare reassignment Care Compare group NPD
• Joshua Caleb Loyd, FNP-BC

  • Family Nurse Practitioner
  • Herrin, IL
  • NPI 1598445405

  Dermatology

  Medicare reassignment Care Compare group NPD
• Shanda Conrad Swagler, F NP-C

  • Family Nurse Practitioner
  • Herrin, IL
  • NPI 1750526810
  Medicare reassignment Care Compare group NPD
• Curtis Lamar Hardy, D.O.

  • Dermatology Physician
  • Chapin, SC
  • NPI 1326469743

  IL, Single Specialty

  Medicare reassignment Care Compare group NPD
• Alexis Elizabeth Lorinskas, PA-C

  • Medical Physician Assistant
  • Carbondale, IL
  • NPI 1255618237
  Medicare reassignment Care Compare group
• Rachel Marie Sargent, PA-C

  • Physician Assistant
  • Carbondale, IL
  • NPI 1164618633
  Medicare reassignment Care Compare group
• Natalie Spiller, PA-C

  • Physician Assistant
  • Herrin, IL
  • NPI 1942550272
  Medicare reassignment Care Compare group
• Amelia Kate Stigall, PA-C

  • Physician Assistant
  • Marion, IL
  • NPI 1578178679
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1152489600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217289600000",
    "number": "1306870233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 N PARK AVE",
            "address_2": "SUITE 2",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "629483150",
            "telephone_number": "618-942-3344",
            "fax_number": "618-942-5045"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 N PARK AVE",
            "address_2": "SUITE 2",
            "city": "HERRIN",
            "state": "IL",
            "postal_code": "629483150",
            "telephone_number": "618-942-3344",
            "fax_number": "618-942-5045"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHERN ILLINOIS DERMATOLOGY, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-10",
        "last_updated": "2008-07-29",
        "status": "A",
        "authorized_official_last_name": "VAN ACKER",
        "authorized_official_first_name": "TED",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "618-942-3344",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D. O."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark L Smith, MD
• Mark Zachary Smith, LPN
• Richard Daniel Smith, D.C.
• Roger Smith, PAC
• Amber-Rose Snowden, SLP
• Southern Illinois Healthcare
• Southern Illinois Hematology Oncology LTD
• Southern Illinois Hospital Services (Herrin Hospital)
• Southern Illinois Hospital Services (Herrin Hospital)
• Southern Illinois Hospital Services (Herrin Hospital)

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 29, 2008; 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.