Active NPI 1053370759 Individual Practitioner Male Practitioner

Dr. Carl William Soderstrom , MD

Dermatology - Dermatopathology • Peoria, IL

Professional Overview & Biography Verified Profile Summary

Dr. Carl Soderstrom, MD is a registered healthcare professional specializing in Dermatology - Dermatopathology in Peoria, IL. Practice services are available at 4909 N GLEN PARK PLACE RD under active NPI credentials.

Frequently performed procedures and clinical services include new patient outpatient office visit, destruction of skin growth, destruction of precancer skin growth, 2-14 growths. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

4909 N Glen Park Place Rd

Peoria, IL 616144676

Telephone 3096747546

Associated Practice Facility / Clinic

🏢 Soderstrom Dermatology Center S C Facility NPI 1053362343

Specialty Benchmarks & Practice Insights

Comparative analytics for Dermatology - Dermatopathology in Peoria, IL

Active Practitioner

Practitioner Clinical Experience

Active

City Avg: 32.0 Yrs

State Avg: 27.9 Yrs

Regional Practice Density

2 Specialists

Practicing in Peoria, IL (17 Statewide)

Telehealth Adoption Rate

0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

12.7% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2023)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	18	18	$111.95	$109.99
17000 Destruction of skin growth	11	11	$71.48	$50.07

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	676	151	$12.41	$6.32
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	288	288	$112.91	$107.92
17000 Destruction of skin growth	204	201	$73.60	$51.57
99213 Established patient office or other outpatient visit, typically 15 minutes	204	198	$90.23	$86.83
11102 Tangential biopsy of single skin lesion	122	121	$158.42	$91.85
17110 Destruction of up to 14 skin growths	110	108	$112.06	$103.63
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	82	82	$170.02	$160.77
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	62	62	$129.59	$121.80
11103 Biopsy of related skin growth, each additional growth	48	37	$57.33	$48.57
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	40	40	$55.60	$54.33
17004 Destruction of precancer skin growth, 15 or more growths	16	16	$185.37	$153.51
11200 Removal of skin tag, 1-15 skin tags	14	14	$89.30	$67.27

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	130	128	$89.60	$87.84
17003 Destruction of precancer skin growth, 2-14 growths	117	38	$11.82	$6.18
11102 Tangential biopsy of single skin lesion	70	68	$155.99	$90.54
17000 Destruction of skin growth	61	60	$71.48	$48.20
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	61	61	$115.53	$109.35
17110 Destruction of up to 14 skin growths	33	31	$110.95	$104.74
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	33	31	$128.30	$124.70
11103 Biopsy of related skin growth, each additional growth	32	17	$54.46	$50.48
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	30	30	$167.52	$164.13
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	27	27	$55.60	$54.10
99202 New patient office or other outpatient visit, typically 20 minutes	13	13	$76.70	$70.57

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	120	113	$74.14	$71.50
17003 Destruction of precancer skin growth, 2-14 growths	115	22	$10.68	$5.67
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	36	24	$77.41	$76.46
17000 Destruction of skin growth	24	24	$79.64	$56.56
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	19	17	$45.31	$41.52
17004 Destruction of precancer skin growth, 15 or more growths	15	15	$151.99	$149.13
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	13	13	$114.92	$106.18
17110 Destruction of up to 14 skin growths	12	12	$108.89	$102.22

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	513	414	$71.03	$69.78
17003 Destruction of precancer skin growth, 2-14 growths	496	105	$9.39	$5.48
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	153	153	$104.77	$103.51
17000 Destruction of skin growth	140	133	$71.48	$55.02
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	127	57	$68.76	$66.67
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	77	61	$117.21	$82.00
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	75	71	$104.29	$103.57
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	70	69	$139.90	$138.86
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	68	63	$20.98	$1.59
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	63	48	$105.82	$92.54
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	62	58	$23.49	$16.05
88305 Pathology examination of tissue using a microscope, intermediate complexity	58	48	$78.79	$65.45
17110 Destruction of up to 14 skin growths	55	54	$102.71	$92.15
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	53	43	$41.84	$41.54
96920 Laser treatment (total area less than 250 sq centimeters) for inflammatory skin disease	52	23	$151.46	$150.20
11102 Tangential biopsy of single skin lesion	48	48	$100.99	$80.07
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	47	41	$131.89	$116.04
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	43	35	$106.38	$81.96
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	35	35	$162.06	$160.85
17004 Destruction of precancer skin growth, 15 or more growths	35	35	$142.88	$141.91
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	34	29	$90.33	$54.35
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	31	27	$114.39	$86.99
11104 Punch biopsy, first skin growth	24	24	$126.96	$116.75
11305 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	20	17	$92.66	$64.11
11312 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	20	17	$151.77	$139.59
99202 New patient office or other outpatient visit, typically 20 minutes	19	19	$71.73	$71.30
11103 Biopsy of related skin growth, each additional growth	18	13	$54.46	$51.21
11307 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	14	13	$135.45	$125.13

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
99213 Established patient office or other outpatient visit, typically 15 minutes	882	684	$70.74	$67.97
17003 Destruction of precancer skin growth, 2-14 growths	875	176	$9.44	$4.89
17000 Destruction of skin growth	232	223	$71.95	$53.05
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	182	58	$68.03	$66.29
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	171	171	$105.15	$100.33
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	134	101	$112.60	$84.91
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	121	118	$104.82	$99.92
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	120	117	$139.90	$136.03
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	102	96	$21.05	$1.77
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	99	85	$107.20	$75.55
17004 Destruction of precancer skin growth, 15 or more growths	96	92	$150.67	$133.38
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	95	91	$23.56	$18.62
11100 Biopsy of single growth of skin and/or tissue	91	90	$97.29	$83.59
17110 Destruction of up to 14 skin growths	87	86	$102.71	$93.77
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	79	64	$133.45	$108.09
96920 Laser treatment (total area less than 250 sq centimeters) for inflammatory skin disease	77	22	$150.14	$147.60
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	69	62	$107.73	$80.14
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	62	46	$91.52	$57.73
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	61	61	$162.06	$154.55
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	57	48	$41.84	$40.38
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	38	33	$114.39	$93.24
11312 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	34	31	$151.77	$136.51
11200 Removal of skin tag, 1-15 skin tags	30	29	$84.30	$56.68
96921 Treatment of inflammatory skin disease using laser, 250.0-500.0 sq cm	27	13	$166.87	$163.71
36415 Insertion of needle into vein for collection of blood sample	26	23	$5.00	$2.94
11305 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	24	20	$92.66	$62.40
11307 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	24	21	$135.45	$115.75
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	21	21	$202.14	$192.83
69100 Biopsy of ear	12	11	$95.01	$68.96

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	3,160	498	$10.52	$5.34
99213 Established patient office or other outpatient visit, typically 15 minutes	2,185	1,438	$71.04	$69.25
17000 Destruction of skin growth	710	610	$72.57	$55.21
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	414	64	$67.96	$64.72
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	356	328	$105.23	$102.19
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	325	226	$112.48	$86.11
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	322	322	$105.58	$102.49
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	262	202	$20.09	$1.77
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	245	195	$23.63	$22.91
88305 Pathology examination of tissue using a microscope, intermediate complexity	243	167	$74.99	$65.28
17004 Destruction of precancer skin growth, 15 or more growths	236	210	$146.10	$139.78
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	214	170	$109.50	$80.34
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	210	201	$140.32	$137.98
96920 Laser treatment (total area less than 250 sq centimeters) for inflammatory skin disease	178	25	$151.46	$145.67
17110 Destruction of up to 14 skin growths	167	152	$117.15	$95.00
11100 Biopsy of single growth of skin and/or tissue	147	144	$100.17	$81.31
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	144	106	$46.18	$41.12
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	140	117	$135.13	$113.97
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	138	138	$163.48	$157.87
11310 Shaving of 0.5 centimeters or less skin growth of face, ears, eyelids, nose, lips, or mouth	132	105	$109.70	$83.90
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	102	90	$115.28	$100.90
11300 Shaving of 0.5 centimeters or less skin growth of the trunk, arms, or legs	94	79	$90.33	$61.40
96921 Treatment of inflammatory skin disease using laser, 250.0-500.0 sq cm	80	17	$166.87	$161.17
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	65	15	$18.96	$18.67
36415 Insertion of needle into vein for collection of blood sample	60	46	$5.52	$2.91
11200 Removal of skin tag, 1-15 skin tags	58	54	$86.61	$68.25
11307 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	47	44	$138.17	$123.76
11312 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	42	38	$151.77	$140.81
11305 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.5 cm or less	37	34	$92.66	$64.93
99202 New patient office or other outpatient visit, typically 20 minutes	36	36	$71.73	$70.45
99205 New patient office or other outpatient visit with a high level of medical decision making, if using time, 60 minutes or more	28	28	$202.14	$198.47
17111 Destruction of skin growth, 15 or more growths	27	22	$134.65	$120.85
11101 Biopsy of each additional growth of skin and/or tissue	23	20	$31.66	$31.06
69100 Biopsy of ear	18	18	$95.01	$65.23
85025 Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count	16	15	$32.61	$10.01
80053 Blood test, comprehensive group of blood chemicals	14	13	$28.80	$13.52

Medical Specialties & State Licenses

Dermatology - Dermatopathology Primary Specialty

NUCC Taxonomy Code: 207ND0900X

A dermatopathologist has the expertise to diagnose and monitor diseases of the skin including infectious, immunologic, degenerative and neoplastic diseases. This entails the examination and interpretation of specially prepared tissue sections, cellular scrapings and smears of skin lesions by means of routine and special (electron and fluorescent) microscopes.

Dermatology

NUCC Taxonomy Code: 207N00000X

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.

Practice Associates & Co-Workers

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

14 Associated Practitioners

Madeline Taylor

Nurse Practitioner - Family

NPI 1033079355

Dr. James Jeffries , MD

Surgery - Plastic and Reconstructive Surgery

NPI 1073655676

Doctor of Medicine (M.D.)

Stuart Berryman , PA-C

Physician Assistant - Medical

NPI 1093774705

Physician Assistant (Certified)

Jordyn Lewandowski , APRN

Nurse Practitioner - Family

NPI 1144892175

Advanced Practice Registered Nurse

Dr. Tesfu Hailu , MD

Dermatology - Dermatopathology

NPI 1245490382

Doctor of Medicine (M.D.)

Dr. John Lomax , MD

Plastic Surgery

NPI 1417923517

Doctor of Medicine (M.D.)

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 4909 N GLEN PARK PLACE RD, PEORIA, IL 616144676 (Tel: 3096747546)

📍

Updated Business Mailing Address July 08, 2007

Registered at 4909 N GLEN PARK PLACE RD, PEORIA, IL 616144676 (Tel: 3096747546)

👤

Provider Name / Credentials Updated July 08, 2007

Recorded as CARL SODERSTROM, M.D.

🎓

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

Dermatology

🟢

Initial NPI Registration & Enumeration March 21, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1053370759

Entity Type:

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

Enumeration Date: March 21, 2006

Last Update: September 11, 2025

Sole Proprietor: No

Update or Correct Profile

Mailing Address

4909 N Glen Park Place Rd

Peoria, IL 616144676

Phone: 3096747546

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

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.