Dermatology and Mohs Surgery Institute, LTD.

Primary specialty

SpecialistTaxonomy code 174400000X

License

036.129240 Issued in 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

Last updated

Jul 9, 2026By 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

Mr. Jeffrey K McKennaNPI 1396713780

Title

Physician Owner

Phone

(309) 451-3376

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 37

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.

• Jeffrey K McKenna, MD

  • MOHS-Micrographic Surgery Physician
  • Charleston, IL
  • NPI 1396713780
  Medicare reassignment Care Compare group NPD Authorized official
• Courtney Garland Bibo, DNP

  • Family Nurse Practitioner
  • East Moline, IL
  • NPI 1679311617
  Medicare reassignment Care Compare group NPD
• Nicole Marie Chum, FNP-BC

  • Family Nurse Practitioner
  • Peru, IL
  • NPI 1699402016
  Medicare reassignment Care Compare group NPD
• Valerie Jackson, APNP

  • Family Nurse Practitioner
  • Charleston, IL
  • NPI 1932689676
  Medicare reassignment Care Compare group NPD
• Wynn Hugh Kao, M.D., PH.D.

  • Dermatology Physician
  • Bloomington, IL
  • NPI 1790996890
  Medicare reassignment Care Compare group NPD
• Stephanie McWhirter, APN

  • Family Nurse Practitioner
  • Moline, IL
  • NPI 1376085365
  Medicare reassignment Care Compare group NPD
• Megan Lesley Glenn, P.A.-C.

  • Physician Assistant
  • Bloomington, IL
  • NPI 1427328798
  Medicare reassignment Care Compare group
• Seema Pasha Apichai, M.D.

  • Anatomic Pathology Physician
  • Chicago, IL
  • NPI 1811204399
  Medicare reassignment NPD
• Jennifer Lynn Stern, APN CNP

  • Family Nurse Practitioner
  • Champaign, IL
  • NPI 1679558985
  Medicare reassignment NPD
• Ashwath Jonathan Sampath, MD

  • Dermatology Physician
  • Chapel Hill, NC
  • NPI 1003470832

  IL

  Medicare reassignment NPD
• Terri A Webber Miller, NP

  • Nurse Practitioner
  • Englewood, CO
  • NPI 1376992818

  IL

  Medicare reassignment NPD
• Karen Lin Chen

  • Physician Assistant
  • Glenview, IL
  • NPI 1558098152
  Medicare reassignment

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

{
    "created_epoch": "1354579200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783555200000",
    "number": "1770828626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "302 INNOVATION DR STE 400",
            "city": "FRANKLIN",
            "state": "TN",
            "postal_code": "370672022",
            "telephone_number": "615-224-7755",
            "fax_number": "615-716-3787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "303 N HERSHEY RD STE B",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617047720",
            "telephone_number": "309-451-3376",
            "fax_number": "309-452-3376"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGY AND MOHS SURGERY INSTITUTE, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-04",
        "last_updated": "2026-07-09",
        "certification_date": "2026-07-09",
        "status": "A",
        "authorized_official_last_name": "MCKENNA",
        "authorized_official_first_name": "JEFFREY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "PHYSICIAN OWNER",
        "authorized_official_telephone_number": "309-451-3376",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": "IL",
            "license": "036.129240",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Dental Professionals of Illinois, P.C. (Redbird Dental Care)
• Dental Professionals of Illinois, P.C. (Hershey Plaza Dental Care)
• Dental Professionals of Illinois, P.C. (Bloomington Smile Center)
• John Scott Denton, M.D.
• Julia Deredowski
• Dermatology and Skin Cancer Center
• Shivani Chetan Desai, DMD
• Debra Descarpentrie, LPC
• Hatem Desoky, M.D.
• Hannah Deterding

• Specialist in Bloomington, IL
• Providers in Bloomington, IL by specialty
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2026; 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.