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DERMATOLOGY AND SKIN CANCER CENTER
NPI 1093596652
Dermatology in Bloomington, IL

Active since October 10, 2023CLIA Certified · 3 labs
3302 GERIG DR STE 100, BLOOMINGTON, IL 61704(309) 533-7070(855) 710-6552 Get Directions Write a Review

NPPES record last updated: December 17, 2024. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Dec 17, 2024, Oct 25, 2023, Oct 10, 2023 (3 updates tracked since 2023).

About Dermatology And Skin Cancer Center NPPES

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

DERMATOLOGY AND SKIN CANCER CENTER (NPI 1093596652) is a healthcare organization registered as a dermatology in Bloomington, Illinois and active in the NPI registry since October 2023. The organization holds 3 active CLIA laboratory certificates, maintains 2 additional practice locations, and lists Adrienne Schupbach, Md/practice Owner, as its authorized official.

NPPES Registry Identity

NPI1093596652
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameDERMATOLOGY AND SKIN CANCER CENTER
Location Address3302 GERIG DR STE 100Bloomington, IL 61704-6343
Mailing Address3302 Gerig Dr Ste 100Bloomington, IL 61704-6343 · (309) 533-7070 · Fax (855) 710-6552
Phone(309) 533-7070
Fax(855) 710-6552
Organization SubpartNo
Authorized OfficialAdrienne SchupbachMd/practice Owner · (309) 533-7070
Enumeration DateOctober 10, 2023
Last NPPES UpdateDecember 17, 20243 updates tracked since enumeration
NPPES CertifiedDecember 17, 2024
✔ NPI 1093596652 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyDermatologyAllopathic & Osteopathic Physicians
Taxonomy Code207N00000X
Definition
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.
Also ListedDermatology · MOHS-Micrographic SurgeryTaxonomy 207ND0101X
3302 GERIG DR STE 100, Bloomington, IL 61704
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Secondary Practice Locations 2

Location 12011 Rock StPeru, IL 61354-1385 · Phone (815) 410-4555 · Fax (855) 710-6552
Location 21508 W Reynolds StPontiac, IL 61764-2811 · Phone (309) 533-7070 · Fax (855) 710-6552

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

CLIA Laboratory Certificates CMS CLIA 3

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Compliance 14D2292136

Dermatology And Skin Cancer Center · Bloomington, IL
Active · expires Dec 22, 2026
CLIA Number14D2292136
Laboratory TypePhysician Office
Certificate Effective DateDecember 23, 2024
Certificate Expiration DateDecember 22, 2026
Laboratory DirectorAdrienne M. Schupbach
Laboratory Phone(309) 635-8677
Laboratory LocationDermatology And Skin Cancer Center3302 Gerig Dr - Ste 100, Bloomington, IL 61704
CLIA data matches this NPI record on: Address Name
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

Certificate of Waiver 14D2307622

Dermatology & Skin Cancer Center · Peru, IL
Active · expires Jul 10, 2028
CLIA Number14D2307622
Laboratory TypePhysician Office
Certificate Effective DateJuly 11, 2026
Certificate Expiration DateJuly 10, 2028
Laboratory DirectorAdrienne M. Schupbach
Laboratory Phone(815) 410-4555
Laboratory LocationDermatology & Skin Cancer Center2011 Rock St - Ste C, Peru, IL 61354
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 14D2315784

Dermatology & Skin Cancer Center · Pontiac, IL
Active · expires Dec 18, 2026
CLIA Number14D2315784
Laboratory TypePhysician Office
Certificate Effective DateDecember 19, 2024
Certificate Expiration DateDecember 18, 2026
Laboratory DirectorAdrienne M. Schupbach
Laboratory Phone(309) 533-7070
Laboratory LocationDermatology & Skin Cancer Center1508 W Reynolds St, Pontiac, IL 61764
CLIA data matches this NPI record on: Address Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 3

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

JOANNE M LAROW DO
Dermatology (MOHS-Micrographic Surgery)
3302 GERIG DR STE 100
BLOOMINGTON, IL 61704
McLean County (309) 533-7070
KELSEY EDDINGTON PA-C
Physician Assistant
3302 GERIG DR STE 100
BLOOMINGTON, IL 61704
McLean County (309) 533-7070
HANNAH BETHANY ATKINS PA-C
Physician Assistant
3302 GERIG DR STE 100
BLOOMINGTON, IL 61704
McLean County (309) 533-7070

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Dermatology And Skin Cancer Center's NPI number?

The NPI number for Dermatology And Skin Cancer Center is 1093596652. It was assigned to this organization in the NPPES registry on October 10, 2023.

Where is Dermatology And Skin Cancer Center located?

Dermatology And Skin Cancer Center is located at 3302 Gerig Dr Ste 100, Bloomington, IL 61704. The listed phone number is (309) 533-7070.

What is Dermatology And Skin Cancer Center's specialty?

The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.

Does Dermatology And Skin Cancer Center hold CLIA laboratory certificates?

Yes. 3 active CLIA laboratory certificates are associated with this NPI under the federal Clinical Laboratory Improvement Amendments program. The certificates are listed in the CLIA Laboratory Certificates section above.

When was this NPI record last updated?

The NPPES record for Dermatology And Skin Cancer Center was last updated on December 17, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 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.