SODERSTROM DERMATOLOGY CENTER S C
NPI 1710931670
Dermatology in Peoria, IL
About Soderstrom Dermatology Center S C NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
SODERSTROM DERMATOLOGY CENTER S C (NPI 1710931670) is a healthcare organization registered as a dermatology in Peoria, Illinois and active in the NPI registry since May 2006. The organization lists Christina M Peugh, Executive Director, as its authorized official.
NPPES Registry Identity
Specialties & Licenses 7
Other Identifiers 1
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment, revalidation and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Soderstrom Dermatology Center S C is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Revalidation Due Date
Revalidation due by March 31, 2027
Medicare-enrolled providers and suppliers confirm their enrollment information with CMS on a set cycle, every 5 years for most and every 3 years for medical equipment suppliers. CMS sets the due date for each enrollment.
Clinicians Billing Medicare Through This Organization
37Medicare enrollment records show 37 clinicians reassign Medicare billing to Soderstrom Dermatology Center S C, which bills Medicare for the services they deliver. Of these, 7 practice at this address and 8 within 10 miles. Listed here are the 20 practicing nearest to this location.
Clinicians by Medicare Specialty 4
Nearest to this location (20)
See all 37Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 Soderstrom Dermatology Center S C's NPI number?
The NPI number for Soderstrom Dermatology Center S C is 1710931670. It was assigned to this organization in the NPPES registry on May 22, 2006.
Where is Soderstrom Dermatology Center S C located?
Soderstrom Dermatology Center S C is located at 4909 N Glen Park Place Rd, Peoria, IL 61614. The listed phone number is (309) 674-7546.
What is Soderstrom Dermatology Center S C's specialty?
The primary specialty registered for this NPI is Dermatology with taxonomy code 207N00000X.
Is Soderstrom Dermatology Center S C enrolled in Medicare?
Yes. Soderstrom Dermatology Center S C is registered in the Medicare PECOS enrollment system.
When is Soderstrom Dermatology Center S C's Medicare revalidation due?
According to the CMS Revalidation Due Date List (October 2026 release), the Medicare Non-DME Part B enrollment for this organization (Iowa, Clinic/Group Practice) is due for revalidation by March 31, 2027. Medicare providers and suppliers revalidate their enrollment every 5 years, and medical equipment suppliers every 3 years. Confirm current requirements with your Medicare Administrative Contractor.
How many clinicians bill Medicare through Soderstrom Dermatology Center S C?
According to the CMS Revalidation Reassignment List (October 2026 release), 37 clinicians in 4 Medicare specialties reassign their Medicare billing to Soderstrom Dermatology Center S C. 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 Dermatology (25), Nurse Practitioner (8) and Pathology (2). Of these, 7 practice at this address and 8 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Soderstrom Dermatology Center S C was last updated on April 8, 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.
# Soderstrom Dermatology Center S C · NPI 1710931670
Dermatology organization in Peoria, Illinois. Organization record, active in the CMS NPPES registry since May 22, 2006.
## Identity
- **NPI:** 1710931670 (Entity type: Organization)
- **Enumerated:** May 22, 2006
- **Primary specialty:** Dermatology · taxonomy 207N00000X
- **Organization subpart:** No
- **Authorized official:** Christina Peugh, EXECUTIVE DIRECTOR
## Practice location
- **Address:** 4909 N GLEN PARK PLACE RD, Peoria, IL 61614-4676
- **Phone:** (309) 674-7546
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Medicare revalidation due:** March 31, 2027 (Non-DME Part B, Iowa, Clinic/Group Practice) · CMS Revalidation Due Date List, October 2026 release
- **Clinicians billing through this organization:** 37 clinicians in 4 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: Dermatology (25), Nurse Practitioner (8), Pathology (2); 7 practice at this address and 8 within 10 miles; [full list](https://npiprofile.com/npi/1710931670/clinicians) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** April 8, 2008
- **Other identifiers:** Medicare PIN 460810 (IL)
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Source: [NPI Profile](https://npiprofile.com/npi/1710931670) · Data from the CMS NPPES public registry.