Prairie Dermatology, PLLC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

PRAIRIE DERMATOLOGY, PLLC

Practice address

1015 S Mercer Ave Ste GF7
Bloomington, IL 61701-7107

Phone

(309) 660-8442

NPI assigned

May 31, 2022

Organization subpart

No

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

Authorized official

Name

Caitlyn Stoewer, PANPI 1235866377

Title

Physician Assistant

Phone

(309) 531-1252

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 2

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.

• Caitlyn Stoewer, PA-C

  • Physician Assistant
  • Bloomington, IL
  • NPI 1235866377
  Medicare reassignment Care Compare group NPD Authorized official
• Michael Thomas Ginnetti, MD

  • Dermatology Physician
  • Bloomington, IL
  • NPI 1316474976
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1653955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1773014400000",
    "number": "1881333680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1015 S MERCER AVE STE GF7",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617017107"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1015 S MERCER AVE STE GF7",
            "city": "BLOOMINGTON",
            "state": "IL",
            "postal_code": "617017107",
            "telephone_number": "309-660-8442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRAIRIE DERMATOLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-31",
        "last_updated": "2026-03-09",
        "certification_date": "2026-03-09",
        "status": "A",
        "authorized_official_last_name": "STOEWER",
        "authorized_official_first_name": "CAITLYN",
        "authorized_official_title_or_position": "PHYSICIAN ASSISTANT",
        "authorized_official_telephone_number": "309-531-1252",
        "authorized_official_credential": "PA"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jeffrey Scott Poulter, M.D.
• April Liane Powell
• Leann Michelle (Croft) Powell, PT, MSPT
• Prairie Counseling Services
• Prairie Dental Associates, P.C.
• Premier Medical Group, LLC (Drs. Kulb, Chalian and Leak Urology)
• Premier Medical Group, LLC (Center for Cosmetic and Laser Surgery, LLC)
• Premier Medical Group, LLC (OB/GYN Care Associates, SC)
• Premier Medical Group, LLC (Barry Slotky, M.D., SC)
• Premier Medical Group, LLC

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

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