NPIMap

Organization Active NPI

Dermatologists of Illinois, PLLC

Doing business as The Skin Care Center

  • Dermatology Physician
  • Lake Forest, IL
National Provider Identifier
1851358345
Registry record updated Aug 26, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
036068947 Issued in IL
Legal business name
DERMATOLOGISTS OF ILLINOIS, PLLC
Doing business as
The Skin Care Center
Practice address
225 E Deerpath Ste 50
Lake Forest, IL 60045-1970
Phone
(847) 234-6121
NPI assigned
Apr 27, 2006
Last updated
Aug 26, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2024

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

Authorized official

Name
Dr. Eugene Brent Kirkland, M.D.
Title
Owner
Phone
(937) 434-2351

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X 036068947 IL Primary

Addresses

Primary practice location

225 E Deerpath Ste 50
Lake Forest, IL 60045-1970

Mailing address

5300 Far Hills Ave
Dayton, OH 45429-2381
Phone (937) 436-4146

Other names 1

  • The Skin Care Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041008001130 IL Part B Supplier - Clinic/Group Practice 9537128004 Receives reassigned benefits from 13 practitioners
Practice locations: Lake Forest, IL; Glenview, IL; Chicago, IL

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
14D2202503Skin Care Center, the225 E Deerpath Rd - Suite #50, Lake Forest, IL 60045ComplianceFeb 12, 2027

National Provider Directory

National Provider Directory

Locations

3000 N Halsted St
Ste 201
Chicago, IL 60657
Phone (773) 296-2636

3000 N Halsted St
Ste 320
Chicago, IL 60657
Phone (773) 296-3636

2551 Compass Rd
Ste 105
Glenview, IL 60026
Phone (847) 901-0252

225 E Deerpath
Ste 50
Lake Forest, IL 60045
Phone (847) 234-6121

Practitioners & affiliated clinicians

Practitioners 17

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 17

NPI Registry JSON

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

{
    "created_epoch": "1146096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724630400000",
    "number": "1851358345",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5300 FAR HILLS AVE",
            "city": "DAYTON",
            "state": "OH",
            "postal_code": "454292381",
            "telephone_number": "937-436-4146",
            "fax_number": "937-530-4083"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 E DEERPATH STE 50",
            "city": "LAKE FOREST",
            "state": "IL",
            "postal_code": "600451970",
            "telephone_number": "847-234-6121"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERMATOLOGISTS OF ILLINOIS, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-04-27",
        "last_updated": "2024-08-26",
        "certification_date": "2024-08-26",
        "status": "A",
        "authorized_official_last_name": "KIRKLAND",
        "authorized_official_first_name": "EUGENE",
        "authorized_official_middle_name": "BRENT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "937-434-2351",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036068947",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Skin Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lake Forest, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2024; 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.