ADVANCED FACIAL PLASTICS & MOHS (NPI# 1922295328) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922295328 |
| Entity Type | Organization |
| Organization Name | ADVANCED FACIAL PLASTICS & MOHS |
| Practice Address |
1235 N Mulford Rd Suite 100 Rockford IL 61107-3879 |
| Practice Telephone | 8154849900 |
| Mailing Telephone | 8154849900 |
| Enumeration Date | 2007-09-28 |
| Last Update Date | 2007-11-08 |
| Authorized Official Name | KIMBERLY MACMURCHY (CONTRACTING AND CREDENTIALING) |
| Authorized Official Telephone | 8154849900 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 208200000X | Plastic Surgery | IL | Allopathic & Osteopathic Physicians | |
| N | 2082S0099X |
Plastic Surgery Specialization: Plastic Surgery Within the Head and Neck |
IL | Allopathic & Osteopathic Physicians | |
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
IL | Allopathic & Osteopathic Physicians |
| Street Address |
1235 N MULFORD RD SUITE 100 |
| City | ROCKFORD |
| State | IL |
| Zip Code | 61107-3879 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821091075 | Susan M Fowell | Ophthalmology | 1235 N Mulford Rd, Suite 100, Rockford, IL 61107-3879 | 2005-05-23 |
| 1164875852 | Bryn Maxine Byers Krause | Nurse Practitioner | 1235 N Mulford Rd, Suite 205, Rockford, IL 61107-3879 | 2016-07-18 |
| 1306211198 | Christine Lenox | Counselor | 1235 N Mulford Rd, Suite 200, Rockford, IL 61107-3879 | 2015-12-06 |
| 1962873919 | Renviva LLC | Clinic/Center | 1235 N Mulford Rd, Rockford, IL 61107-3879 | 2015-10-16 |
| 1578971487 | Northern Illinois Trauma Regional Orthopaedics, LLC | Orthopaedic Surgery | 1235 N Mulford Rd, Suite 103, Rockford, IL 61107-3879 | 2014-07-24 |
| 1598053571 | Stephanie Jo Drake | Physical Therapy Assistant | 1235 N Mulford Rd, Rockford, IL 61107-3879 | 2011-07-12 |
| 1932437290 | Surgical Services of Illinois, Sc | Dermatology | 1235 N Mulford Rd, Ste. 205, Rockford, IL 61107-3879 | 2009-11-25 |
| 1154576221 | Tanya J. Munger | Registered Nurse | 1235 N Mulford Rd, Suite 222, Rockford, IL 61107-3879 | 2008-11-17 |
| 1376714600 | Laura Koch | Clinical Nurse Specialist | 1235 N Mulford Rd, Suite 200, Rockford, IL 61107-3879 | 2008-03-14 |
| 1669640504 | Todd D Alexander Md Sc | Neurological Surgery | 1235 N Mulford Rd, Suite 210, Rockford, IL 61107-3879 | 2008-02-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356952139 | Jessica Marie Tamayo Fernandez | Pharmacist | 1145 Alpine Rd, Rockford, IL 61107 | 2020-08-13 |
| 1467092379 | Unknown Safa Fatima | Student in an Organized Health Care Education/Training Program | Mercyhealth Mulford Clinic, 5970 Churchview Drive, Rockford, IL 61107 | 2020-01-08 |
| 1194367912 | Matt J Kriebs | Nurse Practitioner | 1235 N Mulford Rd Suite 103, Rockford, IL 61107 | 2019-10-14 |
| 1265962336 | Mary Golembeck | Nurse Practitioner | 7290 Argus Dr, Rockford, IL 61107 | 2017-06-12 |
| 1831644749 | Tessa Lee | Occupational Therapist | 3422 Lauderdale Ln, Rockford, IL 61107 | 2016-08-20 |
| 1942626965 | Elevated Health Essentials, LLC | Chiropractor | 124 N Water St Ste 204e, Rockford, IL 61107 | 2014-03-14 |
| 1093139909 | Swedishamerican Hospital | Surgery | 1639 N Alpine Rd Ste 400, Rockford, IL 61107 | 2014-02-12 |
| 1346676582 | Christopher Anthony Ziganto | Pharmacist | 494 Bienterra Trail #2, Rockford, IL 61107 | 2013-09-19 |
| 1023358272 | Lavanya Durairajan | Physical Therapist | 7358 Shiligton Dr, Rockford, IL 61107 | 2013-02-26 |
| 1851523146 | Great Smiles of Rockford | Durable Medical Equipment & Medical Supplies | 780 N. Mulfrord Road, Rockford, IL 61107 | 2009-08-20 |
| Find all providers in zip 61107 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932437290 | Surgical Services of Illinois, Sc | Dermatology | 1235 N Mulford Rd, Ste. 205, Rockford, IL 61107-3879 | 2009-11-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295374270 | Lilly Aesthetics Sc | Dermatology | 2500 S Highland Ave Ste 220, Lombard, IL 60148-7103 | 2019-12-23 |
| 1194270637 | University Dermatology and Vein Clinic LLC | Dermatology | 8110 Cass Ave, Darien, IL 60561-5013 | 2016-08-24 |
| 1174984959 | Advanced Skin and Mohs Surgery Center S.c. | Dermatology | 2845 N. Sheridan Road, Ste 912, Chicago, IL 60657 | 2016-03-08 |
| 1376915629 | Forefront Dermatology, S.c. | Dermatology | 1520 Bond St, Naperville, IL 60563 | 2015-10-27 |
| 1710294756 | Tracy Campbell Md LLC | Dermatology | 675 W North Ave Ste 506, Melrose Park, IL 60160-1626 | 2010-09-13 |
| 1932388865 | Marsh Dermatology, Sc | Dermatology | 1252 American Way, Libertyville, IL 60048-3936 | 2007-10-27 |
| 1538200308 | Omeed Memar | Dermatology | 50 E Washington St Ste 200, Chicago, IL 60602-2154 | 2007-02-12 |
| 1891721965 | Aleksandar L Krunic | Dermatology | 5140 N California Ave Ste 660, Chicago, IL 60625-3664 | 2006-06-23 |
| 1073595690 | Ashish C Bhatia | Dermatology | 550 E Devon Ave Ste 200, Itasca, IL 60143-2639 | 2005-11-18 |
| 1538153960 | Sharon Louise Horton | Dermatology | 1049 E Wilson St, Suite 190, Batavia, IL 60510-2474 | 2005-08-31 |
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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.