PRAIRIE DERMATOLOGY, PLLC
NPI 1881333680
Dermatology in Bloomington, IL

Active since May 31, 2022CLIA 14D2270251 · Certificate of Compliance
1015 S MERCER AVE STE GF7, BLOOMINGTON, IL 61701(309) 660-8442 Get Directions Write a Review

NPPES record last updated: March 9, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Mar 9, 2026, Nov 23, 2022 (2 updates tracked since 2022).

About Prairie Dermatology, Pllc NPPES

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

PRAIRIE DERMATOLOGY, PLLC (NPI 1881333680) is a healthcare organization registered as a dermatology in Bloomington, Illinois and active in the NPI registry since May 2022. The organization holds a CLIA Certificate of Compliance certificate valid through December 30, 2026 and lists Caitlyn Stoewer, Physician Assistant, as its authorized official.

NPPES Registry Identity

NPI1881333680
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NamePRAIRIE DERMATOLOGY, PLLC
Location Address1015 S MERCER AVE STE GF7Bloomington, IL 61701-7107
Mailing Address1015 S Mercer Ave Ste Gf7Bloomington, IL 61701-7107
Organization SubpartNo
Authorized OfficialCaitlyn StoewerPhysician Assistant · (309) 531-1252
Enumeration DateMay 31, 2022
Last NPPES UpdateMarch 9, 20262 updates tracked since enumeration
NPPES CertifiedMarch 9, 2026
NPI 1881333680 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.
1015 S MERCER AVE STE GF7, Bloomington, IL 61701

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

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 14D2270251

Prairie Dermatology · Bloomington, IL
Active · expires Dec 30, 2026
CLIA Number14D2270251
Laboratory TypePhysician Office
Certificate Effective DateDecember 31, 2024
Certificate Expiration DateDecember 30, 2026
Laboratory DirectorMichael T. Ginnetti
Laboratory Phone(309) 660-8442
Laboratory LocationPrairie Dermatology1015 S Mercer Ave - Ste Gf7, Bloomington, IL 61701
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.

Other Providers at the Same Location NPPES 2

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

Physician Assistant
1015 S MERCER AVE STE GF7
BLOOMINGTON, IL 61701
Dermatology
1015 S MERCER AVE STE GF7
BLOOMINGTON, IL 61701

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 Prairie Dermatology, PLLC's NPI number?

The NPI number for Prairie Dermatology, PLLC is 1881333680. It was assigned to this organization in the NPPES registry on May 31, 2022.

Where is Prairie Dermatology, PLLC located?

Prairie Dermatology, PLLC is located at 1015 S Mercer Ave Ste Gf7, Bloomington, IL 61701. The listed phone number is (309) 660-8442.

What is Prairie Dermatology, PLLC's specialty?

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

Does Prairie Dermatology, PLLC hold a CLIA laboratory certificate?

Yes. A Certificate of Compliance (number 14D2270251) is associated with this NPI, valid through December 30, 2026. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Prairie Dermatology, PLLC was last updated on March 9, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 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.