INTEGRATED DERMATOLOGY OF NORTHEAST MISSOURI LLC
NPI 1992518658
Dermatology in Hannibal, MO

Active since January 28, 2025
163 MEDICAL DR, HANNIBAL, MO 63401(573) 719-1818 Get Directions Write a Review

NPPES record last updated: January 28, 2025. Verified against the NPPES registry weekly; last sync: November 01, 2026.

About Integrated Dermatology Of Northeast Missouri Llc NPPES

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

INTEGRATED DERMATOLOGY OF NORTHEAST MISSOURI LLC (NPI 1992518658) is a healthcare organization registered as a dermatology in Hannibal, Missouri and active in the NPI registry since January 2025. The organization lists Jeffrey Queen, Authorized Official, as its authorized official.

NPPES Registry Identity

NPI1992518658
Entity TypeOrganization
Primary Taxonomy207N00000X
Legal Business NameINTEGRATED DERMATOLOGY OF NORTHEAST MISSOURI LLC
Location Address163 MEDICAL DRHannibal, MO 63401-6884
Mailing Address4700 Exchange Ct Ste 110Boca Raton, FL 33431-4450 · (561) 314-2000
Organization SubpartNo
Authorized OfficialJeffrey QueenAuthorized Official · (561) 231-2635
Enumeration DateJanuary 28, 2025
NPPES CertifiedJanuary 28, 2025
✔ NPI 1992518658 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.
163 MEDICAL DR, Hannibal, MO 63401

Other Names 1

Former Legal Business NameIntegrated Dermatology Of Northeast Missouri Llc

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

Accepted Insurance

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Integrated Dermatology Of Northeast Missouri Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

5

Medicare enrollment records show 5 clinicians reassign Medicare billing to Integrated Dermatology Of Northeast Missouri LLC, which bills Medicare for the services they deliver. Of these, 2 practice at this address and 3 within 10 miles. They are listed nearest first.

Clinicians, nearest first (5)

Nurse Practitioner
NPI 1396500559
163 MEDICAL DR
Hannibal, MO 63401
(573) 719-1818
✔ PECOS✔ Accepts MedicareSame address
Nurse Practitioner
NPI 1487343810
163 MEDICAL DR
Hannibal, MO 63401
(573) 719-1818
✔ PECOS✔ Accepts MedicareSame address
Dermatology
NPI 1679552350
163 MEDICAL DR
Hannibal, MO 63401
(573) 248-3900
✔ PECOS✔ Accepts Medicare2.2 mi
Nurse Practitioner
NPI 1558379735
211 S 3RD ST
Louisiana, MO 63353
(573) 754-5555
✔ PECOS✔ Accepts Medicare29 mi
Nurse Practitioner
NPI 1104204122
1 DOT WAY
Mount Sterling, IL 62353
(217) 773-6060
✔ PECOS✔ Accepts Medicare41 mi

Source: 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 Integrated Dermatology Of Northeast Missouri LLC's NPI number?

The NPI number for Integrated Dermatology Of Northeast Missouri LLC is 1992518658. It was assigned to this organization in the NPPES registry on January 28, 2025.

Where is Integrated Dermatology Of Northeast Missouri LLC located?

Integrated Dermatology Of Northeast Missouri LLC is located at 163 Medical Dr, Hannibal, MO 63401. The listed phone number is (573) 719-1818.

What is Integrated Dermatology Of Northeast Missouri LLC's specialty?

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

Is Integrated Dermatology Of Northeast Missouri LLC enrolled in Medicare?

Yes. Integrated Dermatology Of Northeast Missouri LLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Integrated Dermatology Of Northeast Missouri LLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 5 clinicians in 2 Medicare specialties reassign their Medicare billing to Integrated Dermatology Of Northeast Missouri LLC. 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 (4) and Dermatology (1). Of these, 2 practice at this address and 3 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Integrated Dermatology Of Northeast Missouri LLC accept?

Health plans from Anthem Blue Cross and Blue Shield list Integrated Dermatology Of Northeast Missouri LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Integrated Dermatology Of Northeast Missouri LLC was last updated on January 28, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 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.