Individual provider Active NPI

Melissa L Stenstrom, MD

  • Dermatology Physician
  • Rockford, IL
National Provider Identifier
1477745255
Registry record updated Jan 30, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
036-126369 Issued in IL
Practice address
1235 N Mulford Rd
Suite 205
Rockford, IL 61107-3879
Phone
(815) 484-9900
Fax
(815) 487-4949
NPI assigned
Aug 15, 2007
Last updated
Jan 30, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 30, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 036-126369 IL Primary
Dermatology Physician 207N00000X 51229-020 WI

Addresses

Primary practice location

1235 N Mulford Rd
Suite 205
Rockford, IL 61107-3879

Mailing address

1235 N Mulford Rd
Suite 205
Rockford, IL 61107-3879
Phone (815) 484-9900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101216000746 IL Practitioner - Dermatology 0143418228 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
University of Missouri, Columbia School of Medicine, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Surgical Services of Illinois, SCGroup PAC ID 3072655687, 7 clinicians

Practice addresses (Care Compare)

1235 N Mulford Rd
Suite 205
Rockford, IL 61107-3879
Phone (815) 484-9900

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.71 of 100Reported as group
Quality
100
Improvement activities
40
Cost
62.35

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision73
Removal of skin lesions959
Removal of nail tissue1-10
Removal or shaving of skin growth210
Skin biopsy266

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036-126369ILMDDermatology Physician
51229-020WIMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Surgical Services of Illinois, SC Dermatology CurrentSince Apr 11, 2014 Accepting new patients
Stenstrom Dermatology SC Dermatology PastSince Jun 16, 2014 Accepting new patients

Locations

1235 N Mulford Rd
Ste 205
Rockford, IL 61107
Phone (815) 484-9900

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1187136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1675036800000",
    "number": "1477745255",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 N MULFORD RD",
            "address_2": "SUITE 205",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611073879",
            "telephone_number": "815-484-9900",
            "fax_number": "815-487-4949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 N MULFORD RD",
            "address_2": "SUITE 205",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611073879",
            "telephone_number": "815-484-9900",
            "fax_number": "815-487-4949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "STENSTROM",
        "first_name": "MELISSA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-15",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036-126369",
            "primary": true
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "WI",
            "license": "51229-020",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rockford, IL

Sources for this page

Verify at the official NPI Registry.