DISTINCTIVE DERMATOLOGYLTD (NPI# 1518028398) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1518028398 |
| Entity Type | Organization |
| Organization Name | DISTINCTIVE DERMATOLOGYLTD |
| Other Organization Name | GREGORY & ASSOCIATES DERMATOLOGY, LTD |
| Practice Address |
510 Fullerton Rd Swansea IL 62226-2970 |
| Mailing Address |
510 Fullerton Road Swansea IL 62226-2970 |
| Practice Telephone | 6182337666 |
| Practice Fax Number | 6182337461 |
| Mailing Telephone | 6182337666 |
| Mailing Fax Number | 6182337461 |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2014-12-26 |
| Authorized Official Name | MS. SUSAN L. JOURNAGAN (PRESIDENT) |
| Authorized Official Telephone | 6182337666 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 363L00000X | Nurse Practitioner | Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207N00000X | Dermatology | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | BCBS GROUP LEGACY # | 8200530 | 01 |
| IL | MEDICARE RR GROUP PTAN | CA2289 | 01 |
| Other Name | Type Code |
|---|---|
| Gregory & Associates Dermatology, LTD | Former Legal Business Name - Organization |
| Street Address |
510 FULLERTON RD |
| City | SWANSEA |
| State | IL |
| Zip Code | 62226-2970 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518944552 | James Franklin Gregory | Dermatology | 510 Fullerton Rd, Swansea, IL 62226-2970 | 2005-12-30 |
| 1598987836 | Susan Lynn Journagan | Dermatology | 510 Fullerton Rd, Swansea, IL 62226-2970 | 2007-05-03 |
| 1295849032 | Laura Lorraine Hackworth | Nurse Practitioner | 510 Fullerton Rd, Swansea, IL 62226-2970 | 2006-08-18 |
| 1669481701 | Ross I Palis | Allergy & Immunology | 510 Fullerton Rd, Swansea, IL 62226-2970 | 2006-08-07 |
| 1497732382 | Terri Denise Furfaro | Nurse Practitioner | 510 Fullerton Rd, Swansea, IL 62226-2970 | 2005-12-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639778160 | Roxanna Lee Gunnels | Nurse Practitioner | 1 Bronze Pointe Plaza Suite 1a, Swansea, IL 62226 | 2020-10-26 |
| 1053969790 | Consistent Medical Transportation | Driver | 2012 N 17th St, Swansea, IL 62226 | 2019-08-27 |
| 1497314371 | Medi-plex Hospice of Illinois, LLC | Registered Nurse | 8 Park Place, Suite #3, Swansea, IL 62226 | 2019-06-13 |
| 1336617364 | Nicole Renee Schmidt | Speech-Language Pathologist | 150 N 27th St., Belleville, IL 62226 | 2018-11-07 |
| 1295258903 | Catherine Espino | Pharmacist | 11 Chambers Blvd, Swansea, IL 62226 | 2017-07-25 |
| 1366806838 | Kiley Faires | Nurse Practitioner | 4600 Memorial Drive Ste 360, Belleville, IL 62226 | 2016-04-11 |
| 1760857585 | Mvp Transportation | Non-emergency Medical Transport (VAN) | 1229 N 17th Street, Number 23, Belleville, IL 62226 | 2015-12-04 |
| 1275952566 | Aisha Danyale Franklin | Internal Medicine | 4261 Woodfield Pl, Belleville, IL 62226 | 2014-04-15 |
| 1396168332 | Jayne E. Ninness | Physical Therapy Assistant | 4500 Memorial Dr., Memorial Hospital, Belleville, IL 62226 | 2014-01-28 |
| 1053758193 | Gateway Foundation, Inc. | Clinic/Center | 1 Bronze Point, Suite 1, Swansea, IL 62226 | 2013-05-30 |
| Find all providers in zip 62226 | ||||
| Taxonomy Code | 207N00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| 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. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source] Additional Resources: American Board of Dermatology, 2007. http://www.abderm.org/ Board certification is provided by the American Board of Dermatology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1518944552 | James Franklin Gregory | Dermatology | 510 Fullerton Rd, Swansea, IL 62226-2970 | 2005-12-30 |
| 1710523618 | Skinpros International Pllc | Dermatology | 1675 Gar Hwy, Swansea, MA 02777-3901 | 2019-11-26 |
| 1962713370 | Erik Domingues | Dermatology | 1675 Gar Hwy, Swansea, MA 02777-3901 | 2010-06-30 |
| 1922260587 | Musick Dermatology & Advanced Clinical Spa, LLC | Dermatology | 4948 Benchmark Centre Dr, Swansea, IL 62226-2027 | 2008-06-25 |
| 1598987836 | Susan Lynn Journagan | Dermatology | 510 Fullerton Rd, Swansea, IL 62226-2970 | 2007-05-03 |
| 1831176775 | Steve Earl Musick I | Dermatology | 4948 Benchmark Centre Dr, Swansea, IL 62226-2027 | 2005-12-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275141251 | Derick Dermatology, LLC | Dermatology | 239 Remington Boulevard, Suite 225, Bolingbrook, IL 60440 | 2020-07-16 |
| 1063030252 | Vitalskin Medical Group Il Pllc | Dermatology | 1111 W Kenyon Rd, Urbana, IL 61801-1010 | 2020-07-14 |
| 1447873831 | Derick Dermatology, LLC | Dermatology | 5250 Old Orchard Rd Ste 110, Skokie, IL 60077-4461 | 2020-05-20 |
| 1346869393 | Julia Katsnelson Md Sc | Dermatology | 231 Olde Half Day Rd, Lincolnshire, IL 60069-2906 | 2020-04-10 |
| 1114551983 | Katherine Janezic | Dermatology | 7447 W Talcott Ave Ste 425, Chicago, IL 60631-3704 | 2020-03-02 |
| 1013559400 | Orsini Surgical Dermatology Sc | Dermatology | 1519 Legacy Cir, Naperville, IL 60563-3161 | 2019-10-17 |
| 1124675244 | Kiracofe Md Medical, LLC | Dermatology | 719 South Blvd # 2903, Oak Park, IL 60302-2903 | 2019-08-22 |
| 1366009664 | Derick Dermatology | Dermatology | 1900 Spring Rd Ste 210, Oak Brook, IL 60523-9063 | 2019-05-22 |
| 1487116240 | Conrad Petersen Dermatology Sc | Dermatology | 2845 N Sheridan, Chicago, IL 60657 | 2019-04-02 |
| 1891257853 | Maria Estela Martinez Escala | Dermatology | 5841 S Maryland Ave Ste Mc5067, Chicago, IL 60637-1443 | 2019-04-01 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.