BLOOMINGTON DERMATOLOGY CLINIC (NPI# 1003914920) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003914920 |
| Entity Type | Organization |
| Organization Name | BLOOMINGTON DERMATOLOGY CLINIC |
| Practice Address |
2001 E 3rd St Bloomington IN 47401-7890 |
| Practice Telephone | 8123330398 |
| Practice Fax Number | 8123330698 |
| Mailing Telephone | 8123330398 |
| Mailing Fax Number | 8123330698 |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2020-05-21 |
| Authorized Official Name | SCOTT M WILHELMUS (C.E.O.) |
| Authorized Official Telephone | 8123330398 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207N00000X | Dermatology | 01042083A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| SOCIAL SECURITY NUMBER | $$$$$$$$$ | 01 | |
| IN | ANTHEM | 000000090314 | 01 |
| Street Address |
2001 E 3RD ST |
| City | BLOOMINGTON |
| State | IN |
| Zip Code | 47401-7890 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740765791 | Holly G Carter | Physical Therapist | 3607 Heirloom Dr, Bloomington, IN 47401 | 2018-09-26 |
| 1285116657 | Kimberly D Bergan | Occupational Therapist | 3607 S Heirloom Dr, Bloomington, IN 47401 | 2018-09-03 |
| 1255836813 | Erin Kathleen Sain | Nurse Practitioner | 326 W Woodcrest Drive, Bloomington, IN 47401 | 2018-03-27 |
| 1881104289 | Ev Bloomington Limited Partnership | Assisted Living Facility | 3607 South Heirloom Drive, Bloomington, IN 47401 | 2017-10-11 |
| 1619496536 | Kirsten N Neely | Physical Therapist | 2604 E. Creek's Edge Dr., Bloomington, IN 47401 | 2017-09-12 |
| 1023533908 | Hoosier United Therapy Service LLC | Physical Therapist | 2801 E Plateau Place, Bloomington, IN 47401 | 2017-08-11 |
| 1194127381 | Ann Marie Neeley | Lactation Consultant, Non-RN | 2458 South Walnut Street, Bloomington, IN 47401 | 2014-09-19 |
| 1518397801 | Indiana Spine and Sports Inc. | Chiropractor | 418 S Walnut St Suite C, Bloomington, IN 47401 | 2013-11-22 |
| 1053654574 | William Robblee Anderson | Obstetrics & Gynecology | 2625 E. Spicewood Ct., Bloomington, IN 47401 | 2013-04-03 |
| 1285979377 | Jenna Marie Dale | Optometrist | 322 S. Woodcrest Drive Precision Eye Group, Bloomington, IN 47401 | 2012-11-30 |
| Find all providers in zip 47401 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740415777 | Adrienne Schupbach | Dermatology | 3024 E Empire St Ste E&f, Bloomington, IL 61704-5402 | 2009-05-19 |
| 1528008414 | Rajagopala Swaminathan | Dermatology | 3024 E Empire St Ste Eandf, Bloomington, IL 61704-5402 | 2006-06-08 |
| 1366442444 | Kent S. Taulbee | Dermatology | 2418 E Lincoln St, Bloomington, IL 61701-5915 | 2005-07-29 |
| 1578567343 | Mary Kathleen Mctigue | Dermatology | 1200 S Rogers St, Bloomington, IN 47403-4792 | 2005-06-09 |
| 1184000531 | Roxanne Rajaii | Dermatology | 1200 S Rogers St, Bloomington, IN 47403-4792 | 2015-08-08 |
| 1669867669 | Michelle Gita Baechtold | Dermatology | 1200 S Rogers St, Bloomington, IN 47403-4792 | 2015-04-06 |
| 1144489618 | Elizabeth Kim Farhat | Dermatology | 7920 Old Cedar Ave S, Bloomington, MN 55425-1207 | 2008-06-09 |
| 1801063128 | Carrie Lynn Davis | Dermatology | 1200 S Rogers St, Bloomington, IN 47403-4792 | 2008-05-15 |
| 1689846909 | Talley Bhanyang Whang | Dermatology | 1200 S Rogers St, Bloomington, IN 47403-4792 | 2008-03-26 |
| 1689863904 | Associates In Dermatology Sc | Dermatology | 1404 Eastland Drive, Suite 204, Bloomington, IL 61701-3532 | 2007-10-23 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 47401 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.