1. Home
  2. Directory
  3. Illinois
  4. Herrin
  5. Dermatology
  6. NPI Profile

SOUTHERN ILLINOIS DERMATOLOGY, PC
NPI 1306870233
Dermatology in Herrin, IL

Active since July 10, 2006CLIA Certified · 5 labs
220 N PARK AVE, SUITE 2, HERRIN, IL 62948(618) 942-3344(618) 942-5045 Get Directions Write a Review

NPPES record last updated: July 29, 2008. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Southern Illinois Dermatology, Pc NPPES

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

SOUTHERN ILLINOIS DERMATOLOGY, PC (NPI 1306870233) is a healthcare organization registered as a dermatology in Herrin, Illinois and active in the NPI registry since July 2006. The organization holds 5 active CLIA laboratory certificates and lists Ted G Van Acker, President, as its authorized official.

NPPES Registry Identity

NPI1306870233
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameSOUTHERN ILLINOIS DERMATOLOGY, PC
Location Address220 N PARK AVE, SUITE 2Herrin, IL 62948-3150
Mailing Address220 N Park Ave, Suite 2Herrin, IL 62948-3150 · (618) 942-3344 · Fax (618) 942-5045
Phone(618) 942-3344
Fax(618) 942-5045
Organization SubpartNo
Authorized OfficialTed G Van AckerPresident · (618) 942-3344
Enumeration DateJuly 10, 2006
Last NPPES UpdateJuly 29, 2008
✔ NPI 1306870233 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ 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.
220 N PARK AVE, Herrin, IL 62948
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Medicare Participation & PECOS CMS

Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Southern Illinois Dermatology, Pc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

11

Medicare enrollment records show 11 clinicians reassign Medicare billing to Southern Illinois Dermatology, PC, which bills Medicare for the services they deliver. Of these, 5 practice at this address and 7 within 10 miles. They are listed nearest first.

Clinicians by Medicare Specialty 3

Nurse Practitioner7
Dermatology3
Pathology1

Clinicians, nearest first (11)

Gerri Dyer, NP
Nurse Practitioner
NPI 1952328486
220 N PARK AVE SUITE 2
Herrin, IL 62948
(618) 942-3344
✔ PECOS✔ Accepts MedicareSame address
Derek Kenneaster, MD
Dermatology
NPI 1457372724
220 N PARK AVE SUITE 2
Herrin, IL 62948
(618) 942-3344
✔ PECOS✔ Accepts MedicareSame address
Joshua Loyd, FNP-BC
Nurse Practitioner
NPI 1598445405
220 N PARK AVE STE 2
Herrin, IL 62948
(618) 942-3344
✔ PECOS✔ Accepts MedicareSame address
Shanda Swagler, F NP-C
Nurse Practitioner
NPI 1750526810
220 N PARK AVE
Herrin, IL 62948
(618) 942-3344
✔ PECOS✔ Accepts MedicareSame address
Ted Van Acker, D.O.
Dermatology
NPI 1720025562
220 N PARK AVE SUITE 2
Herrin, IL 62948
(618) 942-3344
✔ PECOS✔ Accepts MedicareSame address
Hope Hargraves, FNP-C
Nurse Practitioner
NPI 1265065007
201 S 14TH ST
Herrin, IL 62948
(618) 942-2171
✔ PECOS0.3 mi
Amy Blandford, APRN
Nurse Practitioner
NPI 1598240145
3333 W DEYOUNG ST
Marion, IL 62959
(618) 998-7000
✔ PECOS4.8 mi
Moses Adeyanju, M.D.
Pathology
NPI 1306820121
405 W JACKSON ST PATHOLOGY DEPARTMENT
Carbondale, IL 62901
(618) 549-0721
✔ PECOS✔ Accepts Medicare12 mi
Karen Wood-Belford, APRN-CNP, FNP-C
Nurse Practitioner
NPI 1902068992
1700 E 38TH ST
Marion, IN 46953
(765) 674-3321
✔ PECOS✔ Accepts Medicare260 mi
Curtis Hardy, D.O.
Dermatology
NPI 1326469743
200 CLARK ST
Chapin, SC 29036
(803) 233-8668
✔ PECOS✔ Accepts Medicare498 mi
Constance Henshaw, FNP-C
Nurse Practitioner
NPI 1760081483
330 W SMALL ST STE #1
Harrisburg, IL 62946
(618) 252-8535
✔ PECOS✔ Accepts Medicare

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

CLIA Laboratory Certificates CMS CLIA 6

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 for Provider-Performed Microscopy Procedures (PPMP) 14D1086614

Southern Illinois Dermatology · West Frankfort, IL
Active · expires Jul 15, 2028
CLIA Number14D1086614
Laboratory TypePhysician Office
Certificate Effective DateJuly 16, 2026
Certificate Expiration DateJuly 15, 2028
Laboratory DirectorDerek Kenneaster MD
Laboratory Phone(618) 942-3344
Laboratory LocationSouthern Illinois Dermatology108 N Emma, West Frankfort, IL 62896
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 14D1052641

Southern Illinois Dermatology · Harrisburg, IL
Active · expires Mar 29, 2028
CLIA Number14D1052641
Laboratory TypePhysician Office
Certificate Effective DateMarch 30, 2026
Certificate Expiration DateMarch 29, 2028
Laboratory DirectorTed G. Van Acker
Laboratory Phone(618) 942-3344
Laboratory LocationSouthern Illinois Dermatology300 Small Street, Suite 1, Harrisburg, IL 62946
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 14D1052642

Southern Illinois Dermatology · Du Quoin, IL
Active · expires Mar 29, 2028
CLIA Number14D1052642
Laboratory TypePhysician Office
Certificate Effective DateMarch 30, 2026
Certificate Expiration DateMarch 29, 2028
Laboratory DirectorTed G. Van Aker
Laboratory Phone(618) 942-3344
Laboratory LocationSouthern Illinois Dermatology111 W Main, Du Quoin, IL 62832
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 14D2099049

Southern Illinois Dermatology · Mount Vernon, IL
Active · expires Jul 19, 2027
CLIA Number14D2099049
Laboratory TypePhysician Office
Certificate Effective DateJuly 20, 2025
Certificate Expiration DateJuly 19, 2027
Laboratory DirectorTed Van Acker Do
Laboratory Phone(618) 942-3344
Laboratory LocationSouthern Illinois Dermatology1007 South 42nd St, Mount Vernon, IL 62864
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 14D2126247

Southern Illinois Dermatology · Vandalia, IL
Active · expires Feb 21, 2027
CLIA Number14D2126247
Laboratory TypePhysician Office
Certificate Effective DateFebruary 22, 2025
Certificate Expiration DateFebruary 21, 2027
Laboratory DirectorTed Van Acker
Laboratory Phone(618) 942-3344
Laboratory LocationSouthern Illinois Dermatology110 South 6th St, Vandalia, IL 62471
CLIA data matches this NPI record on: Name Phone
This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

Certificate of Compliance 14D0917950

Southern Illinois Dermatology · Herrin, IL
Expired · Sep 30, 2026
CLIA Number14D0917950
Laboratory TypePhysician Office
Certificate Effective DateAugust 2, 2024
Certificate Expiration DateSeptember 30, 2026
Laboratory DirectorTed G. Van Acker
Laboratory Phone(618) 942-3344
Laboratory LocationSouthern Illinois Dermatology220 N Park Avenue, Herrin, IL 62948
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory after an inspection that finds the laboratory to be in compliance with all applicable CLIA requirements.

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 Southern Illinois Dermatology, PC's NPI number?

The NPI number for Southern Illinois Dermatology, PC is 1306870233. It was assigned to this organization in the NPPES registry on July 10, 2006.

Where is Southern Illinois Dermatology, PC located?

Southern Illinois Dermatology, PC is located at 220 N Park Ave Suite 2, Herrin, IL 62948. The listed phone number is (618) 942-3344.

What is Southern Illinois Dermatology, PC's specialty?

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

Is Southern Illinois Dermatology, PC enrolled in Medicare?

Yes. Southern Illinois Dermatology, PC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Southern Illinois Dermatology, PC?

According to the CMS Revalidation Reassignment List (October 2026 release), 11 clinicians in 3 Medicare specialties reassign their Medicare billing to Southern Illinois Dermatology, PC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are Nurse Practitioner (7), Dermatology (3) and Pathology (1). Of these, 5 practice at this address and 7 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Does Southern Illinois Dermatology, PC hold CLIA laboratory certificates?

Yes. 5 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 Southern Illinois Dermatology, PC was last updated on July 29, 2008. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 years 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.