DR. CARL WILLIAM JR. SODERSTROM (M.D.) – Dermatopathology Physician, NPI 1053370759
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Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
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Provider Addresses for DR. CARL WILLIAM JR. SODERSTROM (M.D.)
4909, North Glen Park Pl Road, Peoria, Peoria County, Illinois, 61614, United States
PEORIA, IL 616144676
Phone: (309) 674-7546
Mailing address matches the actual address.
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $15.
Total Amount is formed as General ($15) + Research ($0) + Ownership ($0) = $15.
Last reported payment date: 2023-03-23 • Largest payer in this snapshot: PFIZER INC. ($15).
Total Amount
$15
General + Research + Ownership
Payments
1
Total payment records
General Amount
$15
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-03-23
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| PFIZER INC. | $15 |
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
No Medicare enrollment or revalidation data available for this provider in our database.
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Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99203 | New patient office or other outpatient visit, 30-44 minutes | 18 | 18 | $0 |
| 17000 | Destruction of precancer skin growth, 1 growth | 11 | 11 | $0 |
Insurance plans in this area (ZIP 61614)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| DERMATOLOGY | IL | 11101 | Biopsy of each additional growth of skin and/or tissue | 56 | 32 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| D E R M A T O L O G Y | IL | |
| Plastic And Reconstructive Surgery | IL | |
| D E R M A T O L O G Y | IA | |
| Physician Assistant | IL | |
| - | IL | |
| Nurse Practitioner | IL | |
| Nurse Practitioner | IL | |
| P A T H O L O G Y | IL | |
| Physician Assistant | IL | |
| - | CA |
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