Surgical Services of Illinois, SC

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

Legal business name

SURGICAL SERVICES OF ILLINOIS, SC

Practice address

1235 N Mulford Rd
Ste. 205
Rockford, IL 61107-3879

Phone

(815) 484-9900

Fax

(815) 487-4949

NPI assigned

Nov 25, 2009

Organization subpart

No

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

Authorized official

Name

Dr. Andrew I. Jun, M.D.NPI 1841270717

Title

President

Phone

(815) 484-9900

Specialties & licenses 12

Addresses

Other identifiers 1

Other names 1

• MD SkinCenter Doing business as

Medicare fee-for-service enrollment

Enrolled in IL

Enrollment records 1

Locations

Practitioners 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Andrew I. Jun, MD

  • Otolaryngology Physician
  • Rockford, IL
  • NPI 1841270717
  Medicare reassignment Care Compare group NPD Authorized official
• Madison Alberts, NP

  • Nurse Practitioner
  • Rockford, IL
  • NPI 1629899893
  Medicare reassignment Care Compare group NPD
• Bryn Maxine Byers Krause, NP

  • Nurse Practitioner
  • Rockford, IL
  • NPI 1164875852
  Medicare reassignment Care Compare group NPD
• Megan Lockard, APN

  • Nurse Practitioner
  • Rockford, IL
  • NPI 1265118087
  Medicare reassignment Care Compare group NPD
• Heather Ann Reese, APN

  • Nurse Practitioner
  • Rockford, IL
  • NPI 1407517311
  Medicare reassignment Care Compare group NPD
• Lori Ann Schultz, NP

  • Nurse Practitioner
  • Rockford, IL
  • NPI 1902995087
  Medicare reassignment Care Compare group NPD
• Melissa L Stenstrom, MD

  • Dermatology Physician
  • Rockford, IL
  • NPI 1477745255
  Medicare reassignment Care Compare group NPD
• Megan Delaney Kemper

  • Nurse Practitioner
  • Rockford, IL
  • NPI 1033063813
  NPD (past)

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

{
    "created_epoch": "1259107200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675036800000",
    "number": "1932437290",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1235 N MULFORD RD",
            "address_2": "STE. 205",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611073879",
            "telephone_number": "815-484-9900",
            "fax_number": "815-487-4949"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1235 N MULFORD RD",
            "address_2": "STE. 205",
            "city": "ROCKFORD",
            "state": "IL",
            "postal_code": "611073879",
            "telephone_number": "815-484-9900",
            "fax_number": "815-487-4949"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SURGICAL SERVICES OF ILLINOIS, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-11-25",
        "last_updated": "2023-01-30",
        "certification_date": "2023-01-30",
        "status": "A",
        "authorized_official_last_name": "JUN",
        "authorized_official_first_name": "ANDREW",
        "authorized_official_middle_name": "I.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-484-9900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207ND0101X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, MOHS-Micrographic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NS0135X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dermatology, Procedural Dermatology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207YP0228X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Pediatric Otolaryngology",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207YS0123X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Facial Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207YX0007X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Plastic Surgery within the Head & Neck",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207YX0602X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Otolaryngic Allergy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207YX0905X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology, Otolaryngology/Facial Plastic Surgery",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID",
            "identifier": "IL2884",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MD SkinCenter",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MD SkinCenter",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Grace Supinski
• Balarama Krishna Surapaneni
• Sure Way Home Health Care
• Sure Way Home Healthcare
• Surgical Associates of Northern Illinois
• Michael Philip Sutton, D.C.
• Stephanie Elin Sutton, LCSW
• Jon Suyko, PHARMD
• Lisa Marie Swank, M.A., LCPC
• Jay Jackson Swanson

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.