DERMASSOCIATES LTD (NPI# 1942273974) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942273974 |
| Entity Type | Organization |
| Organization Name | DERMASSOCIATES LTD |
| Practice Address |
3608 W Main St Belleville IL 62226-6225 |
| Practice Telephone | 6183976605 |
| Practice Fax Number | 6182771251 |
| Mailing Telephone | 6183976605 |
| Mailing Fax Number | 6182771251 |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | DR. GARY JOHN VICIK (CEO/PHYSICIAN) |
| Authorized Official Telephone | 6183976605 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 174400000X | Specialist | 36-49185 | IL | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| UNITEDHEALTHCARE | STL0307017 | 01 | |
| GREAT WEST | 202982 | 01 | |
| GROUP HEALTH PLAN | 42561V34432 | 01 | |
| HEALTHLINK | 101263 | 01 | |
| ESSENCE | 11512 | 01 | |
| ADVANTRA | 42561V34432 | 01 | |
| IL | BLUE SHIELD | 8215117 | 01 |
| AETNA | 0778106 | 01 |
| Street Address |
3608 W MAIN ST |
| City | BELLEVILLE |
| State | IL |
| Zip Code | 62226-6225 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184857674 | Jami Lee Mannle | Nurse Practitioner | 3608 W Main St, Belleville, IL 62226-6225 | 2009-08-31 |
| 1588790984 | William Lay | Pharmacy | 3608 W Main St, Belleville, IL 62226-6225 | 2007-02-27 |
| 1295708212 | Gary John Vicik | Specialist | 3608 W Main St, Belleville, IL 62226-6225 | 2006-02-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639778160 | Roxanna Lee Gunnels | Nurse Practitioner | 1 Bronze Pointe Plaza Suite 1a, Swansea, IL 62226 | 2020-10-26 |
| 1053969790 | Consistent Medical Transportation | Driver | 2012 N 17th St, Swansea, IL 62226 | 2019-08-27 |
| 1497314371 | Medi-plex Hospice of Illinois, LLC | Registered Nurse | 8 Park Place, Suite #3, Swansea, IL 62226 | 2019-06-13 |
| 1336617364 | Nicole Renee Schmidt | Speech-Language Pathologist | 150 N 27th St., Belleville, IL 62226 | 2018-11-07 |
| 1295258903 | Catherine Espino | Pharmacist | 11 Chambers Blvd, Swansea, IL 62226 | 2017-07-25 |
| 1366806838 | Kiley Faires | Nurse Practitioner | 4600 Memorial Drive Ste 360, Belleville, IL 62226 | 2016-04-11 |
| 1760857585 | Mvp Transportation | Non-emergency Medical Transport (VAN) | 1229 N 17th Street, Number 23, Belleville, IL 62226 | 2015-12-04 |
| 1275952566 | Aisha Danyale Franklin | Internal Medicine | 4261 Woodfield Pl, Belleville, IL 62226 | 2014-04-15 |
| 1396168332 | Jayne E. Ninness | Physical Therapy Assistant | 4500 Memorial Dr., Memorial Hospital, Belleville, IL 62226 | 2014-01-28 |
| 1053758193 | Gateway Foundation, Inc. | Clinic/Center | 1 Bronze Point, Suite 1, Swansea, IL 62226 | 2013-05-30 |
| Find all providers in zip 62226 | ||||
| Taxonomy Code | 174400000X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |
| Notes: Source: Expanded from Webster’s II New Riverside University Dictionary, Boston: Riverside Publishing Company, 1974. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1962946699 | Ginette Ngomatip | Specialist | 89 Moore Pl, Belleville, NJ 07109-1941 | 2016-12-14 |
| 1851688428 | Medistat | Specialist | 8511 Oakville Waltz Rd, Belleville, MI 48111-9504 | 2011-07-05 |
| 1275825382 | Jennie R Cadet | Specialist | 79 Preston St, Belleville, NJ 07109-2268 | 2011-05-07 |
| 1922316702 | Deborah Kay Elimon | Specialist | 7201 W Main St, Belleville, IL 62223-3023 | 2010-09-15 |
| 1003015942 | Karen Lynn Bassimer | Specialist | 16 Eagle Dr, Belleville, IL 62221-4403 | 2007-07-11 |
| 1477603165 | Strategic Transtitions Consulting | Specialist | 49071 Denton Rd Apt 206, Belleville, MI 48111-2107 | 2007-01-12 |
| 1851397319 | Ravi Kumar | Specialist | 211 S 3rd St, Belleville, IL 62220-1915 | 2005-06-21 |
| 1427462597 | Neurological Institute of Interventional Pain Management Pllc | Specialist | 11650 Belleville Rd, Suite 105, Belleville, MI 48111-3380 | 2014-06-17 |
| 1851735450 | Mark S. Feldman, M.d. P.C. | Specialist | 311 W Lincoln St, Suite 100, Belleville, IL 62220-1902 | 2013-04-25 |
| 1497026686 | Belleville Endoscopy | Specialist | 311 W Lincoln St, Suite 100, Belleville, IL 62220-1902 | 2012-01-19 |
| Find all providers in BELLEVILLE | ||||
| City | BELLEVILLE |
| Zip Code | 62226 |
Please comment or provide details below to improve the information on DERMASSOCIATES LTD.
| 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.