Michael L Hayes, D.O.

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

036-107830 Issued in IL

Practice address

4909 N Glen Park Place Rd
Peoria, IL 61614-4676

Phone

(309) 674-7546

NPI assigned

Aug 30, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

DermatologyAlso: Family Practice

Education

Other, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Soderstrom Dermatology Center S CGroup PAC ID 2062432651, 31 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• St Mary Medical Center Hospital, Galesburg, IL, CCN 140064

Merit-based Incentive Payment System (MIPS)

Final score

75 of 100Reported as group

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: csoderstrom1@directaddress.net
• Direct secure messaging: mhayes@directaddress.net

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Soderstrom Dermatology Center S C

  • Dermatology Physician
  • Peoria, IL
  • NPI 1710931670
  Medicare reassignment Care Compare group NPD
• Soderstrom Dermatology Center S C

  • Ambulatory Surgical Clinic/Center
  • Peoria, IL
  • NPI 1053362343
  NPD
• Bergman Cosmetic Surgery, PC

  • Plastic Surgery Physician
  • Des Moines, IA
  • NPI 1689629503
  NPD (past)
• Urban Effects Medspa Inc.

  • Family Nurse Practitioner
  • Clive, IA
  • NPI 1649560236
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• St Mary Medical Center

  • General Acute Care Hospital
  • Galesburg, IL
  • NPI 1164485363
  Care Compare affiliation

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

{
    "created_epoch": "1156896000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1218758400000",
    "number": "1912017245",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4909 N GLEN PARK PLACE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144676",
            "telephone_number": "309-674-7546"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4909 N GLEN PARK PLACE RD",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616144676",
            "telephone_number": "309-674-7546"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HAYES",
        "first_name": "MICHAEL",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-30",
        "last_updated": "2008-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IL",
            "license": "036-107830",
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "IL",
            "license": "036-107830",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IA",
            "license": "02938",
            "primary": false
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": "IA",
            "license": "02938",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Samantha Robin Hawkins, MD
• Tamara Sue Hayden, MSED., LCPC
• Muhammad Sibtain Hayee, MD
• Ann N Hayes, LCPC
• Evelyn Hayes
• Michael P Hayes
• Stephanie M Hayes, PT
• Haynes Family Chiropractic, Inc.
• Julie Haynes, RPH
• Alfred Otis Hazzard Jr., PHARMD

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.