NPIMap

Organization Active NPI

Mohs Surgery &Dermatology

  • Specialist
  • Elgin, IL
National Provider Identifier
1356721591
Registry record updated Jun 3, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
036.137205 Issued in IL
Legal business name
MOHS SURGERY &DERMATOLOGY
Practice address
1750 N Randall Rd
Suite 120
Elgin, IL 60123-7900
Phone
(847) 608-6647
NPI assigned
Jun 3, 2015
Last updated
Jun 3, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2015

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

Authorized official

Name
Ms. Kim Greenough
Title
Office Manager
Phone
(847) 608-6647

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 036.137205 IL Primary

Addresses

Primary practice location

1750 N Randall Rd
Suite 120
Elgin, IL 60123-7900

Mailing address

1750 N Randall Rd
Suite 120
Elgin, IL 60123-7900
Phone (847) 608-6647

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
14D1079340Mohs Surgery and Dermatology Center1750 N Randall Rd, Suite 120, Elgin, IL 60123ComplianceJul 31, 2026

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 30

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.

View all 30

NPI Registry JSON

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

{
    "created_epoch": "1433289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1433289600000",
    "number": "1356721591",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1750 N RANDALL RD",
            "address_2": "SUITE 120",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601237900",
            "telephone_number": "847-608-6647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 N RANDALL RD",
            "address_2": "SUITE 120",
            "city": "ELGIN",
            "state": "IL",
            "postal_code": "601237900",
            "telephone_number": "847-608-6647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOHS SURGERY &DERMATOLOGY",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-06-03",
        "last_updated": "2015-06-03",
        "status": "A",
        "authorized_official_last_name": "GREENOUGH",
        "authorized_official_first_name": "KIM",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "847-608-6647",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "036.137205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Elgin, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • 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.