Dermatology and Mohs Surgery Institute, LTD.
Organization Active NPI Specialist · Bloomington, IL
NPI 1770828626 · NPPES record last updated Jul 9, 2026
Key facts
- NPI
- 1770828626
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- License
- 036.129240 (IL)
- Legal business name
- DERMATOLOGY AND MOHS SURGERY INSTITUTE, LTD.
- Practice address
- 303 N Hershey Rd Ste B
Bloomington, IL 61704-7720 - Phone
- (309) 451-3376
- Fax
- (309) 452-3376
- NPI assigned
- Dec 4, 2012
- Organization subpart
- No
Authorized official
- Name
- Mr. Jeffrey K McKenna
- Title
- Physician Owner
- Phone
- (309) 451-3376
Practitioners 37
-
Nicole Marie Chum, FNP-BC
-
Valerie Jackson, APNP
-
Wynn Hugh Kao, M.D., PH.D.
-
Stephanie McWhirter, APN
-
Megan Lesley Glenn, P.A.-C.
-
Seema Pasha Apichai, M.D.
-
Jennifer Lynn Stern, APN CNP
-
Mindy Marchelle Sanders, PA-C
-
Nazreenbanu Jolly, PA-C
-
Kurt Ashack, M.D.
-
Richard J Ashack, MD
-
Eileen Larkin Axibal, M.D.
-
Lisa M Bedford, MD
-
Elizabeth Susan Cabrera, PA-C
-
Stephen Colden Cahill, D.O.
-
Daniel C. Dapprich, M.D.
-
Melanie Dominguez, PA-C
-
Anna Friedrich, NP
-
Karen J Garbowitz, PA-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 14D2054063 | Dermatology & Mohs Surgery Institute | Compliance | Oct 10, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20130618000425 | IL | Part B Supplier - Clinic/Group Practice | 3870732191 |
Receives reassigned benefits from 15 practitioners Practice locations: Lincoln, IL; Streator, IL; Springfield, IL; Princeton, IL; Pontiac, IL; Peru, IL; Peoria, IL; Pekin, IL… |
National Provider Directory
Locations
3024 E Empire St
Fl 2
Bloomington, IL 61704
Phone (309) 556-7800
3024 E Empire St
Ste Ef
Bloomington, IL 61704
Phone (309) 556-7900
3024 E Empire St
Ste F
Bloomington, IL 61704
180 S Main St
Canton, IL 61520
Phone (309) 647-5240
108 S Main Ste 4a
Canton, IL 61520
180 S Main St
Ste 4A
Canton, IL 61520
108 S Main St Ste a
Canton, IL 61520
108 S Main St
Ste 4a
Canton, IL 61520
101 S Main St
Eureka, IL 61530
626 N Chicago St
Lincoln, IL 62656
200 Richmond Ave E
Mattoon, IL 61938
Phone (217) 234-7000
1200 N State Route 121
Mt Zion, IL 62549
Phone (217) 864-5531
600 S 13th St
Ste F
Pekin, IL 61554
2355 Broadway St
Pekin, IL 61554
Phone (309) 347-1632
812 W Trailcreek Dr
Peoria, IL 61614
Phone (309) 655-7788
1508 W Reynolds St
Pontiac, IL 61764
Phone (309) 533-7070
1739 Oak St
Ste Bc
Quincy, IL 62301
1739 Oak St
#B
Quincy, IL 62301
104 W 6th St
Ste 301
Streator, IL 61364
Phone (815) 673-5522
111 Spring St
#5
Streator, IL 61364
111 Spring St
Ste 5EAST
Streator, IL 61364
111 Spring St
Fl 5
Streator, IL 61364
Phone (815) 673-2353
111 Spring St
Fl E
Streator, IL 61364
111 Spring St
Ste 5E
Streator, IL 61364
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | 036.129240 | IL | Yes |
Addresses
Primary practice location
303 N Hershey Rd Ste B
Bloomington, IL 61704-7720
Mailing address
302 Innovation Dr Ste 400
Franklin, TN 37067-2022
Phone (615) 224-7755
Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.