CMS-1500 Box 24J / 33a • NPI
1245173129
Type 2 Organization (Box 32a/33a)
HIPAA NUCC Taxonomy • CMS Code
207N00000X (CMS 07)
Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist)
Box 32 Service Location & ZIP+4
1201 PINE ST, ELDORADO, IL, 62930-1634
✓ 9-Digit EDI 837 ZIP+4 (62930-1634)
✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR:
NPI
1245173129 (DEACONESS ILLINOIS SPECIALTY CLINIC, INC.) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).
CMS Medicare Order & Referring PECOS Eligibility
Official CMS NPPES Credential & Practice Profile
| 10-Digit NPI Number | 1245173129 (NPI-2 Organization / Facility) |
|---|---|
| Provider / Legal Name | DEACONESS ILLINOIS SPECIALTY CLINIC, INC. |
| Plain-English Specialty | Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist) NUCC Code: 207N00000X (Dermatology) |
| Certifying / Licensing Body | American Board of Dermatology (ABD) |
| Practice Location Address | 1201 PINE ST, ELDORADO, IL, 62930-1634 |
| Practice Telephone / Fax | Tel: (812) 450-6815 | Fax: (812) 450-6822 |
| Administrative Mailing Address | PO BOX 632331, CINCINNATI, OH, 45263-2331 |
| Enumeration & Last Sync | Enumerated: 2026-04-14 | CMS Record Updated: 2026-04-14 |
| Authorized Official | KYLE DILLMAN (Secretary / Treasurer) |
Clinic Location, Accessibility & Directions
📍 Practice Location & Patient Access
🗺️ Open in Google Maps 🏥 More Providers in ELDORADO
🔒 Are you DEACONESS ILLINOIS SPECIALTY CLINIC, INC.? Get your Verified NPI Clinic Badge or request personal phone/address redaction →
Plain-English Taxonomy & CMS Crosswalk (207N00000X)
What Does Taxonomy Code 207N00000X Mean?
In the HIPAA National Uniform Claim Committee (NUCC) classification, code 207N00000X translates to:
"Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist)"
Specialty Clinical Procedures & Therapeutic Classes
Standard Scope of Care (DEACONESS ILLINOIS SPECIALTY CLINIC, INC.)
Typical CPT / Diagnostic Procedures:- Full-Body Dermoscopy & Skin Cancer Screening
- Shave, Punch & Excisional Skin Biopsy (CPT 11102–11107)
- Cryotherapy Destruction of Actinic Keratoses & Viral Warts (CPT 17000)
- Topical Corticosteroids (Triamcinolone, Clobetasol) & Calcineurin Inhibitors
- Topical & Oral Retinoids (Tretinoin, Adapalene, Isotretinoin)
- Doxycycline, Minocycline & Antifungals (Terbinafine, Ketoconazole)
All Registered NUCC Taxonomies & State Licenses
| Taxonomy Code & Plain-English Description | State License & Primary Status |
|---|---|
363A00000X — Physician AssistantPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Physician Assistant | State: N/A | License: Verified | Primary: Secondary |
363L00000X — Nurse PractitionerPlain English: Licensed & Credentialed Physician Assistants & Advanced Practice Nursing Providers — Nurse Practitioner | State: N/A | License: Verified | Primary: Secondary |
207N00000X — DermatologyPlain English: Board-Certified Dermatologist (Skin, Hair & Nail Medical/Surgical Specialist) | State: N/A | License: Verified | Primary: Yes (Primary) |
Medical Billing, RCM & Hospital Credentialing Teams:
Batch-verify up to 25 NPIs free against CMS NPPES + Medicare PECOS + HHS OIG Exclusions with 1-click CSV export.