Soderstrom Dermatology Center S C
NPI 1053362343 · Ambulatory Surgical Clinic/Center · Peoria, IL
Enrolled with Medicare as Part B Supplier - Ambulatory Surgical Center · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Soderstrom Dermatology Center S C is a Ambulatory Surgical Clinic/Center organization in Peoria, IL (NPI 1053362343).
Provider details
- NPI number
- 1053362343
- Entity type
- Organization
- Primary specialty
- Ambulatory Surgical Clinic/CenterAmbulatory Health Care Facilities
- Parent organization
- Soderstrom Dermatology Center S C
- Organization subpart
- Yes
- Authorized official
- Tina Peugh, Executive Director, Soderstrom Derm(309) 674-7546
- License
- 7001530 (IL)
Specialties & taxonomies
Ambulatory Health Care Facilities
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure28% of score
20 yrs in NPPES registry
- Profile completeness28% of score
100% of core fields populated
- Practice footprint17% of score
1 documented practice location
- Medicare service volume (vs. specialty peers)28% of score
2,174 Medicare services, 2024 (ranked within specialty)
Medicare volume is ranked against active providers in the same specialty. Signals a provider has no public data for (e.g. Medicare claims) are left out of the score entirely — never counted as zero — so providers without that data are not penalized. See the full formula and weights in our methodology.
What this provider does (Medicare)
Based on Medicare fee-for-service claims, 2024; not all care is captured.
| Service (HCPCS) | Medicare services | Typical Medicare-allowed (2024) |
|---|---|---|
| Removal and Microscopic Exam of Growth of Head, Neck, Hands, Feet, Or Genitals, 1-5 Tissue Blocks17311 | 698 | $240 |
| Complicated Repair of Wound of Scalp, Arms, Or Legs, 2.6-7.5 Cm13121 | 274 | $216 |
| Complicated Repair of Wound of Forehead, Cheeks, Chin, Mouth, Neck, Underarms, Genitals, Hands, Or Feet, 2.6-7.5 Cm13132 | 254 | $169 |
| Complicated Repair of Wound of Trunk, 2.6-7.5 Cm13101 | 128 | $240 |
| Repair of Wound of Eyelids, Nose, Ears, Or Lips By Transferring Skin, 10.0 Sq Cm Or Less14060 | 119 | $840 |
| Removal of Cancer Skin Growth of Body, Arms, Or Legs, 1.1-2.0 Cm |
Practice location
Mailing address
Other names (DBA / former)
- Doing business as
- Peoria Ambulatory Surgery Center
Registry dates
- Enumerated
- 2006-05-12
- Last updated
- 2008-06-25
Frequently asked questions
- What is Soderstrom Dermatology Center S C's NPI number?
- Soderstrom Dermatology Center S C's National Provider Identifier (NPI) is 1053362343, a unique 10-digit ID issued by CMS for use in standard healthcare transactions.
- What type of organization is Soderstrom Dermatology Center S C?
- Soderstrom Dermatology Center S C is classified in the NPPES registry as Ambulatory Surgical Clinic/Center (Ambulatory Health Care Facilities).
- Where is Soderstrom Dermatology Center S C located?
- Soderstrom Dermatology Center S C's practice location on file with NPPES is 4909 N Glen Park Place Rd, Peoria, IL 61614-4676.
- What is Soderstrom Dermatology Center S C's phone number?
- The practice phone number listed in the NPPES registry for Soderstrom Dermatology Center S C is (309) 690-6012.
- Does Soderstrom Dermatology Center S C accept Medicare?
- Soderstrom Dermatology Center S C is approved to bill Medicare according to CMS PECOS enrollment data (2026.04.01). Confirm current participation with the provider before scheduling.
- Who is the authorized official for Soderstrom Dermatology Center S C?
- The authorized official listed on Soderstrom Dermatology Center S C's NPPES record is Tina Peugh, Executive Director, Soderstrom Derm. The authorized official registers and maintains the organization's NPI and is not necessarily its owner.
- Is Soderstrom Dermatology Center S C's NPI active?
- Yes — Soderstrom Dermatology Center S C's NPI (1053362343) is active in the NPPES registry as of the last update on 2008-06-25.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.