DR. CARL WILLIAM SODERSTROM JR. M.D.
NPI 1053370759
Dermatology - Dermatopathology in Peoria, IL

Q: What is Carl Soderstrom's NPI number?

The NPI number for Carl Soderstrom is 1053370759. It was assigned to this individual provider in the NPPES registry on March 21, 2006.

Q: What is Carl Soderstrom's specialty?

The primary specialty registered for this NPI is Dermatology, specializing in Dermatopathology, with taxonomy code 207ND0900X.

Q: When was this NPI record last updated?

The NPPES record for Carl Soderstrom was last updated on September 11, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 21, 2006

4909 N GLEN PARK PLACE RD, PEORIA, IL 61614(309) 674-7546 Get Directions Write a Review

NPPES record last updated: September 11, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

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About Dr. Carl William Soderstrom Jr. M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. CARL WILLIAM SODERSTROM JR. M.D. (NPI 1053370759) is an individual dermatopathology provider in Peoria, Illinois and active in the NPI registry since March 2006.

NPPES Registry Identity

NPI1053370759

Entity TypeIndividualMale

Primary Taxonomy207ND0900X

Provider Legal NameDR. CARL WILLIAM SODERSTROM JR.Credential: M.D.

Location Address4909 N GLEN PARK PLACE RDPeoria, IL 61614-4676

Mailing Address4909 N Glen Park Place RdPeoria, IL 61614-4676 · (309) 674-7546

Phone(309) 674-7546

Sole ProprietorNo

Enumeration DateMarch 21, 2006

Last NPPES UpdateSeptember 11, 2025

✔ NPI 1053370759 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDermatology · DermatopathologyAllopathic & Osteopathic Physicians

Taxonomy Code207ND0900X

Definition

A dermatopathologist has the expertise to diagnose and monitor diseases of the skin including infectious, immunologic, degenerative and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings and smears of skin lesions by means of routine and special (electron and fluorescent) microscopes.

Also ListedDermatologyTaxonomy 207N00000X

4909 N GLEN PARK PLACE RD, Peoria, IL 61614

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Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

Reported Quality Measures

Biopsy Follow-Up

Percentage of new patients whose biopsy results have been reviewed and communicated to the primary care/referring physician and patient by the performing physician

78%208 patients3/55-star benchmark: 100%

Documentation of Current Medications in the Medical Record

Percentage of visits for patients aged 18 years and older for which the eligible professional or eligible clinician attests to documenting a list of current medications using all immediate resources available on the date of the encounter.

98%2,075 patients4/55-star benchmark: 100%

e-Prescribing

At least one permissible prescription written by the MIPS eligible clinician is queried for a drug formulary and transmitted electronically using certified EHR technology.

99%9,319 patients4/55-star benchmark: 100%

Patient-Specific Education

The MIPS eligible clinician must use clinically relevant information from CEHRT to identify patient-specific educational resources and provide access to those materials to at least one unique patient seen by the MIPS eligible clinician.

0%4,672 patients1/55-star benchmark: 100%

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan

Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous twelve months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous…

29%2,005 patients2/55-star benchmark: 97%

Preventive Care and Screening: Influenza Immunization

Percentage of patients aged 6 months and older seen for a visit between October 1 and March 31 who received an influenza immunization OR who reported previous receipt of an influenza immunization

0%1,514 patients1/55-star benchmark: 88%

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

Percentage of patients aged 18 years and older who were screened for tobacco use one or more times within 24 months AND who received tobacco cessation intervention if identified as a tobacco user

Patients tobacco: 67% · 1,541 patients

76%1,541 patients

Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling

Percentage of patients aged 18 years and older who were screened for unhealthy alcohol use using a systematic screening method at least once within the last 24 months AND who received brief counseling if identified as an unhealthy alcohol user

63%1,538 patients3/55-star benchmark: 100%

Provide Patient Access

At least one patient seen by the MIPS eligible clinician during the performance period is provided timely access to view online, download, and transmit to a third party their health information subject to the MIPS eligible clinician's discretion to withhold…

1%4,672 patients1/55-star benchmark: 100%

Psoriasis: Tuberculosis (TB) Prevention for Patients with Psoriasis, Psoriatic Arthritis and Rheumatoid Arthritis Patients on a Biological Immune Response Modifier

Percentage of patients whose providers are ensuring active tuberculosis prevention either through yearly negative standard tuberculosis screening tests or are reviewing the patient's history to determine if they have had appropriate management for a recent or…

65%48 patients

Secure Messaging

For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of CEHRT to the patient (or the patient-authorized representative), or in response to a secure…

1%4,672 patients1/55-star benchmark: 79%

Tobacco Use and Help with Quitting Among Adolescents

The percentage of adolescents 12 to 20 years of age with a primary care visit during the measurement year for whom tobacco use status was documented and received help with quitting if identified as a tobacco user

62%116 patients

Providers report different measures because they deliver different services; reporting more or less information is not a reflection of quality. Star ratings appear only where CMS assigned them.

Other Providers at the Same Location NPPES 16

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

TAYLOR MARIE WELLS MD

Dermatology