Active NPI 1871506931 Individual Practitioner Male Practitioner

John R Soderstrom , PA

Physician Assistant • Peoria, IL

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

John Soderstrom, PA is a certified Physician Assistant practicing in Peoria, IL. With approximately 20 years of clinical experience since completing medical education in 2006, John Soderstrom delivers high-quality medical care to the local community at 4909 N GLEN PARK PLACE RD.

John Soderstrom is affiliated with Soderstrom Dermatology Center S C and accepts Medicare assignment.

Frequently performed procedures and clinical services include destruction of precancer skin growth, 2-14 growths, established patient outpatient office visit, destruction of skin growth. 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

Medicare Profile & Education

Medical School

Other

Graduation Year

2006

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Physician Assistant in Peoria, IL

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

20 Yrs +7.9 yrs vs City Avg

City Avg: 12.1 Yrs

State Avg: 11.7 Yrs

Regional Practice Density

96 Specialists

Practicing in Peoria, IL (4958 Statewide)

Telehealth Adoption Rate

10.4% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

69.3% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Soderstrom (20 Years) 20 Yrs

Peoria Specialty Average (12.1 Years) 12.1 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
17003 Destruction of precancer skin growth, 2-14 growths	6,506	737	$55.00	$5.17
99213 Established patient office or other outpatient visit, typically 15 minutes	2,226	1,230	$150.00	$73.52
17000 Destruction of skin growth	1,239	817	$185.00	$46.06
17004 Destruction of precancer skin growth, 15 or more growths	370	265	$525.00	$133.26
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	274	135	$20.75	$0.97
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	242	151	$200.00	$104.19
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	227	114	$35.00	$11.39
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	212	162	$310.00	$99.02
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	209	164	$290.00	$81.25
17110 Destruction of up to 14 skin growths	170	149	$250.00	$82.49
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	83	72	$285.00	$84.76
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	58	51	$315.00	$97.28
11200 Removal of skin tag, 1-15 skin tags	50	44	$210.60	$60.00
11900 Injection into skin growth, 1-7 growths	49	34	$155.00	$37.12
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	32	27	$410.00	$135.55
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	27	20	$400.00	$100.82
11104 Punch biopsy, first skin growth	25	24	$375.00	$94.69
11102 Tangential biopsy of single skin lesion	23	23	$261.96	$70.74
11312 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	20	19	$355.00	$123.50
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	17	17	$125.00	$45.76
10040 Acne surgery	16	15	$265.00	$86.66
11307 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	13	13	$320.00	$110.27
36415 Insertion of needle into vein for collection of blood sample	13	11	$12.92	$8.65

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	6,239	720	$13.54	$5.34
99213 Established patient office or other outpatient visit, typically 15 minutes	1,866	1,174	$91.79	$74.69
17000 Destruction of skin growth	1,181	815	$75.70	$45.69
17004 Destruction of precancer skin growth, 15 or more growths	364	250	$172.02	$138.76
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	324	234	$161.40	$80.84
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	306	158	$20.55	$1.06
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	236	129	$24.17	$11.45
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	216	174	$149.57	$102.12
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	214	161	$131.39	$105.47
17110 Destruction of up to 14 skin growths	180	159	$140.00	$79.79
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	180	178	$55.74	$46.65
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	113	95	$168.87	$87.74
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	78	62	$159.89	$100.54
11200 Removal of skin tag, 1-15 skin tags	74	63	$90.86	$60.53
11900 Injection into skin growth, 1-7 growths	60	37	$60.25	$36.02
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	57	51	$187.59	$139.59
11102 Tangential biopsy of single skin lesion	52	52	$158.00	$73.98
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	35	30	$157.31	$109.17
11312 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	34	30	$166.59	$121.52
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	29	26	$177.23	$131.97
11104 Punch biopsy, first skin growth	28	24	$126.99	$102.68
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	22	13	$115.89	$93.16
17111 Destruction of skin growth, 15 or more growths	20	18	$130.62	$97.48
11307 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	18	15	$163.69	$105.09
17271 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	16	15	$188.77	$133.10
17282 Destruction of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	14	13	$206.88	$164.05

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	6,384	726	$12.20	$5.40
99213 Established patient office or other outpatient visit, typically 15 minutes	3,146	1,543	$90.23	$74.40
17000 Destruction of skin growth	1,252	826	$72.68	$44.75
17110 Destruction of up to 14 skin growths	386	308	$112.22	$83.22
17004 Destruction of precancer skin growth, 15 or more growths	383	258	$168.14	$136.46
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	357	34	$116.73	$92.61
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	346	235	$151.95	$77.82
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	334	180	$19.49	$1.13
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	261	208	$141.43	$101.12
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	244	142	$23.78	$11.56
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	199	155	$129.77	$104.51
96920 Laser treatment (total area less than 250 sq centimeters) for inflammatory skin disease	156	14	$161.08	$126.99
11200 Removal of skin tag, 1-15 skin tags	146	127	$94.51	$53.65
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	136	115	$134.08	$87.14
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	74	68	$160.11	$103.42
11900 Injection into skin growth, 1-7 growths	71	49	$56.63	$39.48
17111 Destruction of skin growth, 15 or more growths	59	42	$130.62	$103.30
11104 Punch biopsy, first skin growth	54	54	$137.18	$97.44
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	40	40	$55.60	$46.37
11102 Tangential biopsy of single skin lesion	36	35	$155.99	$73.02
11312 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	34	30	$177.59	$117.20
36415 Insertion of needle into vein for collection of blood sample	28	23	$5.00	$2.96
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	27	22	$189.98	$123.68
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	27	27	$111.95	$92.95
11307 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	21	18	$144.15	$107.27
17271 Destruction of cancer skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	16	13	$164.49	$126.84
99211 Office or other outpatient visit for the evaluation and management of established patient that may not require presence of healthcare professional	15	11	$22.79	$18.63

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	4,500	537	$12.07	$5.22
99213 Established patient office or other outpatient visit, typically 15 minutes	2,158	1,211	$85.52	$75.54
17000 Destruction of skin growth	847	608	$72.97	$43.84
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	322	225	$144.13	$84.43
17004 Destruction of precancer skin growth, 15 or more growths	274	198	$162.81	$135.87
17110 Destruction of up to 14 skin growths	253	211	$114.49	$80.58
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	208	169	$137.82	$105.93
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	205	126	$18.90	$1.28
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	175	160	$118.83	$108.14
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	142	95	$23.57	$11.56
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	130	104	$130.05	$90.41
11200 Removal of skin tag, 1-15 skin tags	92	81	$93.21	$52.86
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	56	27	$112.88	$94.16
11900 Injection into skin growth, 1-7 growths	52	37	$55.26	$41.61
17111 Destruction of skin growth, 15 or more growths	51	38	$144.38	$103.73
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	46	42	$52.56	$46.25
36415 Insertion of needle into vein for collection of blood sample	32	25	$5.00	$3.00
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	27	24	$154.94	$108.38
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	27	27	$113.67	$93.82
11104 Punch biopsy, first skin growth	25	25	$126.96	$104.43
11312 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	15	14	$160.12	$132.03
17281 Destruction of malignant growth (0.6 to 1.0 centimeters) of face, ears, eyelids, nose, lips, or mouth	15	14	$217.28	$143.73
11102 Tangential biopsy of single skin lesion	11	11	$150.99	$69.48

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	3,265	360	$11.05	$4.88
99213 Established patient office or other outpatient visit, typically 15 minutes	1,534	823	$75.31	$62.44
17000 Destruction of skin growth	559	404	$73.85	$46.02
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	230	210	$110.31	$90.44
17004 Destruction of precancer skin growth, 15 or more growths	202	138	$161.49	$129.62
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	187	132	$121.28	$80.52
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	163	130	$131.16	$100.15
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	152	87	$19.59	$1.44
17110 Destruction of up to 14 skin growths	136	123	$110.50	$81.69
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	111	71	$21.33	$11.84
11200 Removal of skin tag, 1-15 skin tags	73	60	$91.64	$51.76
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	67	33	$98.33	$85.09
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	61	56	$123.03	$91.16
17111 Destruction of skin growth, 15 or more growths	49	29	$145.47	$103.25
11900 Injection into skin growth, 1-7 growths	38	20	$67.38	$37.09
11102 Tangential biopsy of single skin lesion	33	32	$100.99	$79.04
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	23	16	$139.55	$98.96
36415 Insertion of needle into vein for collection of blood sample	22	18	$6.07	$2.99
11104 Punch biopsy, first skin growth	20	20	$126.96	$103.91
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	19	14	$48.12	$37.85

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	3,184	362	$10.34	$4.60
99213 Established patient office or other outpatient visit, typically 15 minutes	1,503	792	$71.62	$60.60
17000 Destruction of skin growth	543	395	$77.25	$44.81
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	318	188	$115.39	$72.53
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	283	252	$105.75	$89.17
17004 Destruction of precancer skin growth, 15 or more growths	275	198	$161.10	$122.78
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	174	130	$113.71	$92.97
17110 Destruction of up to 14 skin growths	148	117	$107.08	$81.44
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	138	86	$19.05	$1.55
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	102	67	$23.56	$13.46
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	89	36	$68.04	$66.23
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	85	73	$115.46	$84.17
11200 Removal of skin tag, 1-15 skin tags	67	54	$84.30	$54.29
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	43	32	$131.89	$102.58
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	36	36	$108.41	$89.34
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	34	21	$41.84	$36.88
17111 Destruction of skin growth, 15 or more growths	32	21	$122.56	$105.18
11900 Injection into skin growth, 1-7 growths	29	20	$52.81	$38.59
11104 Punch biopsy, first skin growth	15	15	$126.96	$100.96
11102 Tangential biopsy of single skin lesion	12	12	$100.99	$80.32

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	2,827	333	$11.46	$4.27
99213 Established patient office or other outpatient visit, typically 15 minutes	1,418	766	$71.95	$59.29
17000 Destruction of skin growth	506	378	$74.78	$44.82
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	318	213	$113.79	$80.34
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	283	253	$105.94	$88.05
17004 Destruction of precancer skin growth, 15 or more growths	252	182	$162.24	$116.36
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	234	169	$107.57	$71.36
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	188	116	$20.00	$1.78
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	156	100	$23.62	$16.36
17110 Destruction of up to 14 skin growths	114	100	$109.38	$79.04
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	85	74	$114.39	$91.23
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	68	68	$105.73	$87.74
11200 Removal of skin tag, 1-15 skin tags	64	53	$86.40	$53.67
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	38	30	$131.89	$104.69
17111 Destruction of skin growth, 15 or more growths	34	27	$122.56	$105.83
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	23	23	$43.56	$35.70
11900 Injection into skin growth, 1-7 growths	23	18	$52.81	$37.15
11100 Biopsy of single growth of skin and/or tissue	22	22	$108.04	$74.71
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	21	18	$79.49	$56.58
99215 Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more	13	13	$157.15	$105.53
96920 Laser treatment (total area less than 250 sq centimeters) for inflammatory skin disease	13	12	$151.46	$131.94
36415 Insertion of needle into vein for collection of blood sample	13	11	$5.00	$2.94

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	3,388	397	$9.99	$4.56
99213 Established patient office or other outpatient visit, typically 15 minutes	1,953	1,032	$71.56	$59.55
17000 Destruction of skin growth	592	448	$73.13	$46.17
17004 Destruction of precancer skin growth, 15 or more growths	383	250	$148.77	$121.81
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	344	316	$105.34	$87.56
11301 Shaving of skin growth of body, arms, or legs, 0.6-1.0 cm	319	195	$115.21	$75.42
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	232	132	$21.39	$1.73
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	204	125	$23.73	$19.85
11311 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 0.6-1.0 cm	203	156	$111.32	$69.36
17110 Destruction of up to 14 skin growths	156	138	$105.82	$79.34
11306 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 0.6-1.0 cm	118	91	$115.93	$88.12
96910 Skin application of tar and ultraviolet B or petrolatum and ultraviolet B	80	37	$68.33	$55.03
11302 Shaving of skin growth of body, arms, or legs, 1.1-2.0 cm	80	64	$138.04	$102.07
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	72	72	$106.59	$87.44
11200 Removal of skin tag, 1-15 skin tags	72	64	$91.30	$58.61
17111 Destruction of skin growth, 15 or more growths	71	49	$139.22	$103.55
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	53	50	$42.59	$35.36
96920 Laser treatment (total area less than 250 sq centimeters) for inflammatory skin disease	48	14	$151.46	$124.57
11100 Biopsy of single growth of skin and/or tissue	31	29	$100.31	$76.22
11312 Shaving of skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	19	18	$151.77	$129.71
11307 Shaving of skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	17	14	$135.45	$106.04
36415 Insertion of needle into vein for collection of blood sample	17	13	$5.00	$2.94

Medical Specialties & State Licenses

Physician Assistant Primary Specialty

NUCC Taxonomy Code: 363A00000X

A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician.

Hospital & Practice Group Affiliations

Soderstrom Dermatology Center S C

4909 N Glen Park Place Rd, Peoria, IL 616144676

Phone: 3096747546

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. Carl Soderstrom , MD

Dermatology - Dermatopathology

NPI 1053370759

Doctor of Medicine (M.D.)

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.)

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 JOHN SODERSTROM, P.A.

🎓

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

Physician Assistant

🟢

Initial NPI Registration & Enumeration August 13, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

0 Reviews

No patient reviews submitted yet for John Soderstrom. Be the first to share your experience!

Only verified registered users can submit ratings, post feedback, and upload facility photos.

NPI Administrative Meta

NPI Number: 1871506931

Entity Type:

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

Enumeration Date: August 13, 2006

Last Update: July 08, 2007

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.