Soderstrom Dermatology Center S C
NPI 1710931670 · Dermatology Physician · Peoria, IL
Enrolled with Medicare as Part B Supplier - Clinic/Group Practice · source: CMS PECOS Public Provider Enrollment (2026.04.01)
Soderstrom Dermatology Center S C is a Dermatology Physician organization in Peoria, IL (NPI 1710931670).
Provider details
- NPI number
- 1710931670
- Entity type
- Organization
- Primary specialty
- Dermatology PhysicianAllopathic & Osteopathic Physicians
- Organization subpart
- No
- Authorized official
- Christina Peugh, Executive Director(309) 674-7546
Specialties & taxonomies
Allopathic & Osteopathic Physicians
- Dermatopathology (Pathology) Physician207ZD0900X
Allopathic & Osteopathic Physicians
- Plastic Surgery Physician208200000X
Allopathic & Osteopathic Physicians
- Surgery Physician208600000X
Allopathic & Osteopathic Physicians
- Dermatopathology Physician207ND0900X
Allopathic & Osteopathic Physicians
- MOHS-Micrographic Surgery Physician207ND0101X
Allopathic & Osteopathic Physicians
- Procedural Dermatology Physician207NS0135X
Profile Score
A profile completeness & documented-activity index — NOT a quality, outcomes, or patient-satisfaction rating.
- Registry tenure38% of score
20 yrs in NPPES registry
- Profile completeness38% of score
100% of core fields populated
- Practice footprint23% of score
1 documented practice location
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.
Practice location
Mailing address
Registry dates
- Enumerated
- 2006-05-22
- Last updated
- 2008-04-08
Frequently asked questions
- What is Soderstrom Dermatology Center S C's NPI number?
- Soderstrom Dermatology Center S C's National Provider Identifier (NPI) is 1710931670, 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 Dermatology Physician (Allopathic & Osteopathic Physicians).
- 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) 674-7546.
- 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 Christina Peugh, Executive Director. 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 (1710931670) is active in the NPPES registry as of the last update on 2008-04-08.
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.