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DERMATOLOGY AND MOHS SURGERY INSTITUTE, LTD.
NPI 1770828626
Specialist in Bloomington, IL

Active since December 04, 2012CLIA Certified · 8 labs
303 N HERSHEY RD STE B, BLOOMINGTON, IL 61704(309) 451-3376(309) 452-3376 Get Directions Write a Review

NPPES record last updated: July 9, 2026. Verified against the NPPES registry weekly; last sync: September 06, 2026.

About Dermatology And Mohs Surgery Institute, Ltd. NPPES

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

DERMATOLOGY AND MOHS SURGERY INSTITUTE, LTD. (NPI 1770828626) is a healthcare organization registered as a specialist in Bloomington, Illinois and active in the NPI registry since December 2012. The organization holds 8 active CLIA laboratory certificates and lists Jeffrey K Mckenna, Physician Owner, as its authorized official.

NPPES Registry Identity

NPI1770828626
Entity TypeOrganization
Primary Taxonomy174400000X
Legal Business NameDERMATOLOGY AND MOHS SURGERY INSTITUTE, LTD.
Location Address303 N HERSHEY RD STE BBloomington, IL 61704-7720
Mailing Address302 Innovation Dr Ste 400Franklin, TN 37067-2022 · (615) 224-7755 · Fax (615) 716-3787
Phone(309) 451-3376
Fax(309) 452-3376
Organization SubpartNo
Authorized OfficialJeffrey K MckennaPhysician Owner · (309) 451-3376
Enumeration DateDecember 4, 2012
Last NPPES UpdateJuly 9, 2026
NPPES CertifiedJuly 9, 2026
✔ NPI 1770828626 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtySpecialistOther Service Providers
Taxonomy Code174400000X
License✔ Licensed in IL · 036.129240
Definition
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.
303 N HERSHEY RD STE B, Bloomington, IL 61704
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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

CLIA Laboratory Certificates CMS CLIA 8

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 14D2054063

Dermatology & Mohs Surgery Institute · Bloomington, IL
Active · expires Oct 10, 2027
CLIA Number14D2054063
Laboratory TypePhysician Office
Certificate Effective DateOctober 11, 2025
Certificate Expiration DateOctober 10, 2027
Laboratory DirectorJeffery Mckenna
Laboratory Phone(309) 451-3376
Laboratory LocationDermatology & Mohs Surgery Institute303 N Hershey Rd, Bloomington, IL 61704
CLIA data matches this NPI record on: Address Phone
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 14D2084029

Dermatology & Mohs Surgery Institute · Peru, IL
Active · expires Sep 16, 2028
CLIA Number14D2084029
Laboratory TypePhysician Office
Certificate Effective DateSeptember 17, 2026
Certificate Expiration DateSeptember 16, 2028
Laboratory DirectorJeffery Mckenna
Laboratory Phone(309) 451-3376
Laboratory LocationDermatology & Mohs Surgery Institute920 West St, Ste 216, Peru, IL 61354
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 14D2084034

Dermatology & Mohs Surgery Institute · Streator, IL
Active · expires Sep 16, 2028
CLIA Number14D2084034
Laboratory TypePhysician Office
Certificate Effective DateSeptember 17, 2026
Certificate Expiration DateSeptember 16, 2028
Laboratory DirectorJeffery Mckenna
Laboratory Phone(309) 451-3376
Laboratory LocationDermatology & Mohs Surgery Institute111 Spring St - 5th Flr East, Streator, IL 61364
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 14D2084042

Dermatology & Mohs Surgery Institute · Eureka, IL
Active · expires Sep 16, 2028
CLIA Number14D2084042
Laboratory TypePhysician Office
Certificate Effective DateSeptember 17, 2026
Certificate Expiration DateSeptember 16, 2028
Laboratory DirectorJeffery Mckenna
Laboratory Phone(309) 451-3376
Laboratory LocationDermatology & Mohs Surgery Institute101 S Majors St, Eureka, IL 61530
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 14D2144002

Dermatology & Mohs Surgery Institute · Princeton, IL
Active · expires Jun 27, 2028
CLIA Number14D2144002
Laboratory TypePhysician Office
Certificate Effective DateJune 28, 2026
Certificate Expiration DateJune 27, 2028
Laboratory DirectorWynn Kao M D
Laboratory Phone(309) 451-3376
Laboratory LocationDermatology & Mohs Surgery Institute530 Park Ave - Ste 205, Princeton, IL 61356
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Certificate of Waiver 14D2227097

Dermatology & Mohs Surgery Institute · Canton, IL
Active · expires Jun 27, 2028
CLIA Number14D2227097
Laboratory TypePhysician Office
Certificate Effective DateJune 28, 2026
Certificate Expiration DateJune 27, 2028
Laboratory DirectorWynn Kao M D
Laboratory Phone(309) 451-3376
Laboratory LocationDermatology & Mohs Surgery Institute180 S Main St - Pod 4A, Canton, IL 61520
CLIA data matches this NPI record on: Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES

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

BRANCHING OFF, INC
Home Health
303 N HERSHEY RD STE B
BLOOMINGTON, IL 61704
McLean County (309) 808-4409

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 Mohs Surgery Institute, Ltd.'s NPI number?

The NPI number for Dermatology And Mohs Surgery Institute, Ltd. is 1770828626. It was assigned to this organization in the NPPES registry on December 4, 2012.

Where is Dermatology And Mohs Surgery Institute, Ltd. located?

Dermatology And Mohs Surgery Institute, Ltd. is located at 303 N Hershey Rd Ste B, Bloomington, IL 61704. The listed phone number is (309) 451-3376.

What is Dermatology And Mohs Surgery Institute, Ltd.'s specialty?

The primary specialty registered for this NPI is Specialist with taxonomy code 174400000X.

Does Dermatology And Mohs Surgery Institute, Ltd. hold CLIA laboratory certificates?

Yes. 8 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 Mohs Surgery Institute, Ltd. was last updated on July 9, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.