Active NPI 1669510400 Individual Practitioner Female Practitioner

Dr. Lucy Nelson Wisdom , MD

Dermatology • Bloomington, IL

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Lucy Wisdom, MD is a certified Dermatology practicing in Bloomington, IL. With approximately 26 years of clinical experience since graduating from Southern Illinois University School Of Medicine in 2000, Dr. Wisdom delivers high-quality medical care to the local community at 1404 EASTLAND DRIVE.

Dr. Wisdom is affiliated with Associates In Dermatology Sc and accepts Medicare assignment.

Frequently performed procedures and clinical services include pathology examination of tissue using a microscope, intermediate complexity, destruction of precancer skin growth, 2-14 growths, established patient outpatient office visit. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

1404 Eastland Drive
Suite 204

Bloomington, IL 61701

Telephone 3096628813

Fax 3096626835

Associated Practice Facility / Clinic

🏢 Surgical Associates Of Bloomington, Ill,ltd Facility NPI 1447355383

Medicare Profile & Education

Medical School

Southern Illinois University School Of Medicine

Graduation Year

2000

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Dermatology in Bloomington, IL

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

26 Yrs +7.3 yrs vs City Avg

City Avg: 18.7 Yrs

State Avg: 23.1 Yrs

Regional Practice Density

8 Specialists

Practicing in Bloomington, IL (673 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

69.5% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Wisdom (26 Years) 26 Yrs

Bloomington Specialty Average (18.7 Years) 18.7 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
88305 Pathology examination of tissue using a microscope, intermediate complexity	1,739	689	$31.89	$25.84
17003 Destruction of precancer skin growth, 2-14 growths	1,131	228	$101.00	$6.08
99213 Established patient office or other outpatient visit, typically 15 minutes	1,113	881	$154.00	$86.77
17000 Destruction of skin growth	438	339	$221.00	$50.03
11102 Tangential biopsy of single skin lesion	296	262	$350.00	$82.34
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	291	252	$251.00	$122.28
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	259	20	$147.00	$106.17
17110 Destruction of up to 14 skin growths	258	239	$343.00	$99.82
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	132	132	$238.00	$106.91
11103 Biopsy of related skin growth, each additional growth	116	75	$188.00	$46.15
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	60	46	$503.00	$124.25
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	55	55	$304.00	$161.47
88304 Pathology examination of tissue using a microscope, moderately low complexity	51	24	$34.71	$15.62
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	44	38	$344.00	$95.04
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	34	27	$292.00	$56.09
17111 Destruction of skin growth, 15 or more growths	29	27	$397.00	$113.11
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	26	25	$114.00	$53.80
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	24	22	$356.00	$87.61
10040 Acne surgery	21	18	$309.00	$108.79
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	18	12	$462.00	$110.11
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	17	17	$76.00	$21.58
11200 Removal of skin tag, 1-15 skin tags	15	15	$328.00	$66.63
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	14	14	$453.00	$127.77
17271 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	12	12	$652.00	$156.65

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,349	479	$101.00	$6.30
88305 Pathology examination of tissue using a microscope, intermediate complexity	1,701	649	$33.88	$26.86
99213 Established patient office or other outpatient visit, typically 15 minutes	1,696	1,360	$154.00	$87.86
17000 Destruction of skin growth	754	628	$221.00	$49.90
17110 Destruction of up to 14 skin growths	459	414	$343.00	$97.22
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	269	219	$251.00	$124.15
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	185	154	$344.00	$102.55
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	183	19	$147.00	$106.92
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	167	167	$238.00	$109.39
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	134	106	$356.00	$93.48
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	130	113	$292.00	$70.38
11102 Tangential biopsy of single skin lesion	115	110	$350.00	$83.78
99202 New patient office or other outpatient visit, typically 20 minutes	103	103	$190.00	$70.30
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	77	66	$503.00	$126.46
88304 Pathology examination of tissue using a microscope, moderately low complexity	53	24	$31.74	$14.69
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	42	39	$462.00	$122.96
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	42	41	$409.00	$105.99
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	39	37	$453.00	$117.09
11305 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	38	36	$307.00	$72.31
17111 Destruction of skin growth, 15 or more growths	36	36	$397.00	$122.10
17004 Destruction of precancer skin growth, 15 or more growths	31	26	$1021.00	$163.22
11103 Biopsy of related skin growth, each additional growth	30	19	$188.00	$48.40
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	30	29	$76.00	$22.04
11200 Removal of skin tag, 1-15 skin tags	30	30	$328.00	$54.90
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	23	19	$581.00	$154.30
17280 Destruction of malignant growth (0.5 centimeters or less) of face, ears, eyelids, nose, lips, or mouth	19	18	$502.00	$121.02
11312 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	19	18	$543.00	$151.89
17260 Destruction of cancer skin growth of trunk, arms, or legs, 0.5 cm or less	18	15	$439.00	$63.85
11307 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	11	11	$488.00	$134.82

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,950	397	$92.00	$6.36
99213 Established patient office or other outpatient visit, typically 15 minutes	1,529	1,192	$140.01	$87.42
88305 Pathology examination of tissue using a microscope, intermediate complexity	1,307	493	$28.17	$25.20
17000 Destruction of skin growth	667	550	$201.00	$48.48
17110 Destruction of up to 14 skin growths	379	343	$312.00	$95.73
99202 New patient office or other outpatient visit, typically 20 minutes	265	265	$173.00	$70.07
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	198	145	$228.00	$122.81
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	181	156	$313.00	$98.58
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	114	95	$412.00	$116.30
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	106	89	$265.00	$67.85
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	92	84	$324.00	$90.02
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	89	11	$134.29	$109.23
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	70	64	$457.00	$130.30
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	67	58	$372.00	$105.26
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	63	57	$420.00	$121.91
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	54	54	$216.00	$107.23
11102 Tangential biopsy of single skin lesion	50	49	$318.00	$76.24
17111 Destruction of skin growth, 15 or more growths	44	36	$361.00	$117.11
11305 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	37	33	$279.00	$81.12
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	31	27	$611.00	$161.95
17004 Destruction of precancer skin growth, 15 or more growths	31	30	$928.00	$156.68
88304 Pathology examination of tissue using a microscope, moderately low complexity	28	14	$15.29	$14.34
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	22	22	$528.00	$152.77
11312 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	19	17	$494.00	$142.35
11307 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	17	16	$444.00	$128.26
17280 Destruction of malignant growth (0.5 centimeters or less) of face, ears, eyelids, nose, lips, or mouth	15	14	$456.00	$106.96
11200 Removal of skin tag, 1-15 skin tags	15	15	$298.00	$60.77
17271 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	13	13	$593.00	$152.69
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	13	13	$69.00	$21.86
17260 Destruction of cancer skin growth of trunk, arms, or legs, 0.5 cm or less	11	11	$399.00	$69.76

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
88305 Pathology examination of tissue using a microscope, intermediate complexity	1,199	453	$29.05	$25.79
17003 Destruction of precancer skin growth, 2-14 growths	1,186	218	$92.00	$6.17
99213 Established patient office or other outpatient visit, typically 15 minutes	1,089	761	$140.00	$89.01
17000 Destruction of skin growth	398	297	$201.00	$50.30
17110 Destruction of up to 14 skin growths	225	202	$312.00	$91.52
99202 New patient office or other outpatient visit, typically 20 minutes	220	220	$173.00	$70.52
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	111	94	$313.00	$96.82
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	93	64	$228.00	$126.87
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	82	75	$412.00	$121.62
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	49	44	$420.00	$124.67
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	47	45	$265.00	$70.98
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	46	43	$324.00	$95.18
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	46	37	$457.00	$117.66
11102 Tangential biopsy of single skin lesion	37	36	$318.00	$74.86
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	32	29	$372.00	$96.34
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	30	25	$528.00	$158.45
17111 Destruction of skin growth, 15 or more growths	23	20	$361.00	$122.37
88304 Pathology examination of tissue using a microscope, moderately low complexity	21	11	$15.48	$14.82
11200 Removal of skin tag, 1-15 skin tags	21	21	$298.00	$43.53
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	19	19	$611.00	$174.33
17271 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	17	15	$593.00	$142.16
17004 Destruction of precancer skin growth, 15 or more growths	16	15	$928.00	$159.77
11312 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	14	14	$494.00	$154.88
11307 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	13	12	$444.00	$134.88
11305 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	11	11	$279.00	$80.53

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	1,235	904	$139.80	$73.11
17003 Destruction of precancer skin growth, 2-14 growths	1,172	255	$91.94	$5.73
88305 Pathology examination of tissue using a microscope, intermediate complexity	720	272	$28.49	$26.44
17000 Destruction of skin growth	426	348	$200.85	$48.76
17110 Destruction of up to 14 skin growths	225	198	$311.53	$95.65
99202 New patient office or other outpatient visit, typically 20 minutes	179	179	$172.82	$74.29
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	138	107	$312.25	$96.12
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	91	61	$227.76	$106.73
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	79	73	$410.28	$124.71
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	63	55	$321.43	$88.15
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	52	49	$265.00	$74.94
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	44	38	$456.00	$124.84
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	42	39	$370.52	$104.17
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	41	37	$420.00	$130.97
11102 Tangential biopsy of single skin lesion	40	40	$317.63	$78.26
17111 Destruction of skin growth, 15 or more growths	30	27	$361.00	$124.15
17004 Destruction of precancer skin growth, 15 or more growths	20	17	$928.00	$153.46
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	17	17	$611.00	$173.99
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	17	17	$528.00	$171.66
11305 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	16	15	$276.13	$73.21

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,554	289	$88.84	$5.46
88305 Pathology examination of tissue using a microscope, intermediate complexity	1,514	467	$31.24	$27.90
99213 Established patient office or other outpatient visit, typically 15 minutes	1,324	950	$134.07	$72.13
17000 Destruction of skin growth	519	411	$193.51	$49.46
17110 Destruction of up to 14 skin growths	261	235	$298.55	$96.07
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	188	12	$126.46	$105.94
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	167	135	$266.92	$100.53
99202 New patient office or other outpatient visit, typically 20 minutes	126	126	$165.70	$73.32
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	118	72	$219.05	$106.07
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	107	88	$276.06	$86.65
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	105	81	$225.61	$65.66
17111 Destruction of skin growth, 15 or more growths	64	52	$346.92	$120.33
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	55	51	$348.95	$119.91
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	54	44	$441.11	$125.91
11102 Tangential biopsy of single skin lesion	48	45	$303.94	$85.16
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	40	33	$367.50	$122.00
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	39	34	$317.95	$99.36
17004 Destruction of precancer skin growth, 15 or more growths	36	32	$890.11	$147.80
11305 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	30	27	$234.53	$72.27
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	29	24	$66.10	$21.69
88304 Pathology examination of tissue using a microscope, moderately low complexity	23	12	$15.09	$14.35
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	20	20	$99.50	$42.72
17260 Destruction of cancer skin growth of trunk, arms, or legs, 0.5 cm or less	16	14	$381.19	$76.06
87220 Tissue fungi or parasites	14	13	$44.29	$4.65
17271 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	13	12	$571.46	$141.90
17280 Destruction of malignant growth (0.5 centimeters or less) of face, ears, eyelids, nose, lips, or mouth	13	11	$436.62	$125.56
11200 Removal of skin tag, 1-15 skin tags	11	11	$285.27	$58.65
99201 New patient office or other outpatient visit, typically 10 minutes	11	11	$146.27	$44.56

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
88305 Pathology examination of tissue using a microscope, intermediate complexity	1,307	422	$28.86	$27.47
17003 Destruction of precancer skin growth, 2-14 growths	1,238	259	$86.56	$5.05
99213 Established patient office or other outpatient visit, typically 15 minutes	1,204	846	$130.53	$70.62
17000 Destruction of skin growth	463	356	$188.31	$50.75
11100 Biopsy of single growth of skin and/or tissue	388	353	$287.90	$92.07
17110 Destruction of up to 14 skin growths	206	190	$291.70	$105.67
11101 Biopsy of each additional growth of skin and/or tissue	156	105	$155.03	$31.85
99202 New patient office or other outpatient visit, typically 20 minutes	145	145	$160.48	$72.72
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	105	60	$212.14	$104.62
17111 Destruction of skin growth, 15 or more growths	49	41	$337.80	$125.43
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	39	37	$427.46	$124.95
17004 Destruction of precancer skin growth, 15 or more growths	28	25	$870.50	$136.54
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	26	23	$65.31	$20.49
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	15	15	$96.67	$42.31
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	14	11	$487.57	$151.72
87220 Tissue fungi or parasites	14	14	$42.86	$5.16
17260 Destruction of cancer skin growth of trunk, arms, or legs, 0.5 cm or less	12	12	$378.50	$73.41
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	11	11	$564.18	$165.25

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
88305 Pathology examination of tissue using a microscope, intermediate complexity	1,150	400	$28.93	$27.64
99213 Established patient office or other outpatient visit, typically 15 minutes	1,039	718	$122.02	$70.24
17003 Destruction of precancer skin growth, 2-14 growths	964	183	$82.51	$5.36
17000 Destruction of skin growth	358	263	$172.82	$52.69
11100 Biopsy of single growth of skin and/or tissue	305	265	$267.00	$88.18
17110 Destruction of up to 14 skin growths	168	150	$268.77	$103.80
99202 New patient office or other outpatient visit, typically 20 minutes	140	140	$153.54	$71.78
11101 Biopsy of each additional growth of skin and/or tissue	106	70	$147.09	$31.96
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	102	56	$195.55	$102.93
17111 Destruction of skin growth, 15 or more growths	34	31	$312.35	$125.28
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	31	28	$406.65	$121.32
17004 Destruction of precancer skin growth, 15 or more growths	22	17	$831.50	$143.90
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	21	14	$472.71	$147.67
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	15	14	$60.60	$19.06
87220 Tissue fungi or parasites	12	12	$41.33	$5.74

Medical Specialties & State Licenses

Dermatology Primary Specialty

NUCC Taxonomy Code: 207N00000X

State License IL 036110740

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.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

036110740 (IL)

Hospital & Practice Group Affiliations

Associates In Dermatology Sc

1404 Eastland Dr, Bloomington, IL 617017904

Phone: 30966288139

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

5 Associated Practitioners

Nichole Rave , PA-C

Dermatology

NPI 1386031045

Physician Assistant (Certified)

Erin Redd , APN CNP

Nurse Practitioner

NPI 1578711586

APNCNP

Dr. Thomas Brander , MD

Dermatology

NPI 1598803330

Doctor of Medicine (M.D.)

Dr. James Seehafer , MD

Dermatology

NPI 1619015450

Doctor of Medicine (M.D.)

Kali Fever , APN, CNP

Nurse Practitioner - Family

NPI 1760764385

Advanced Practice Nurse, Certified Nurse Practitioner

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

6 Historical Events

✅

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

📍

Updated Practice Location July 08, 2007

Registered at 1404 EASTLAND DRIVE, SUITE 204, BLOOMINGTON, IL 61701 (Tel: 3096628813)

📍

Updated Business Mailing Address July 08, 2007

Registered at 1404 EASTLAND DRIVE, SUITE 204, BLOOMINGTON, IL 61701 (Tel: 3096628813)

👤

Provider Name / Credentials Updated July 08, 2007

Recorded as LUCY WISDOM, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dermatology (License #036110740 in IL)

🟢

Initial NPI Registration & Enumeration February 02, 2007

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1669510400

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: February 02, 2007

Last Update: July 08, 2007

Sole Proprietor: No

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Mailing Address

1404 Eastland Drive, Suite 204

Bloomington, IL 61701

Phone: 3096628813

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

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