Rockford Dermatology SC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

042617821 Issued in IL

Legal business name

ROCKFORD DERMATOLOGY SC

Practice address

4338 Morsay Dr
Rockford, IL 61107-4877

Phone

(815) 399-6400

Fax

(815) 399-4424

NPI assigned

Sep 20, 2006

Last updated

Feb 19, 2018By 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. Lakimerly Michelle Coates, MDNPI 1871576264

Title

President

Phone

(815) 399-6400

Specialties & licenses 2

Addresses

Other identifiers 4

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 3

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.

• Lakimerly Michelle Coates, MD

  • Dermatology Physician
  • Morgantown, WV
  • NPI 1871576264

  IL

  Medicare reassignment NPD Authorized official
• Kandise Rosenbaum, D.C.

  • Chiropractor
  • Rockford, IL
  • NPI 1285023887
  NPD (past)
• Kiran Jasmine Singh, PA-C

  • Physician Assistant
  • Arlington Heights, IL
  • NPI 1386309912
  NPD (past)

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1518998400000",
    "number": "1487751335",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4338 MORSAY DR",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611074877",
            "telephone_number": "815-399-6400",
            "fax_number": "815-399-4424"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4338 MORSAY DR",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611074877",
            "telephone_number": "815-399-6400",
            "fax_number": "815-399-4424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROCKFORD DERMATOLOGY SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2018-02-19",
        "status": "A",
        "authorized_official_last_name": "COATES",
        "authorized_official_first_name": "LAKIMERLY",
        "authorized_official_middle_name": "MICHELLE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-399-6400",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "042617821",
            "primary": true
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "",
            "desc": "Dermatology, Procedural Dermatology",
            "state": "IL",
            "license": "042617821",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP #",
            "identifier": "203521",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7847308",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "10132043",
            "state": "IL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036102903",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Rockford Associated Pathologists LTD
• Rockford Cardiology Associates, LTD
• Rockford Chiropractic Neurology and Nutrition Center, LTD.
• Rockford Dental Care, P.C.
• Rockford Dental Lounge Inc
• Rockford Emergency Physicians, LLC
• Rockford Family Dental P.C.
• Rockford Family Planning Foundation
• Rockford Gastroenterology Associates, LTD.
• Rockford Gastroenterology Associates, LTD. (Rockford Endoscopy Center)

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 19, 2018; 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.