NPIMap

Organization Active NPI

Quincy Physicians & Surgeons Clinic, PLLC

Doing business as Quincy Medical Group Barry Affiliate

  • Rural Health Clinic/Center
  • Barry, IL
National Provider Identifier
1013981547
Registry record updated Dec 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC
Doing business as
Quincy Medical Group Barry Affiliate
Practice address
868 Mortimer St
Barry, IL 62312-1249
Phone
(217) 335-2343
NPI assigned
Feb 13, 2006
Last updated
Dec 20, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
QUINCY PHYSICIANS & SURGEONS CLINIC, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Dec 20, 2021

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mrs. Patricia A. Williamson
Title
Cfo
Phone
(217) 222-6550

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Rural Health Clinic/Center 261QR1300X NU Primary

Addresses

Primary practice location

868 Mortimer St
Barry, IL 62312-1249

Mailing address

868 Mortimer St
Barry, IL 62312-1249
Phone (217) 335-2343

Other names 1

  • QUINCY MEDICAL GROUP BARRY AFFILIATE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20031103000445 IL Part B Supplier - Clinic/Group Practice 0749192375 Receives reassigned benefits from 263 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Quincy, IL; Springfield, IL; Winchester, IL; Pittsfield, IL; Barry, IL; Camp Point, IL; Carthage, IL; Lisle, IL…
O20101105000211 IL Part A Provider - Rural Health Clinic 0749192375 Practice locations: Barry, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1013981547. Details of each certification follow.

Rural health clinic certification: CCN 148900

Legal name
QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC
Doing business as
QUINCY MEDICAL GROUP BARRY AFFILIATE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 1, 1998
Last certification
Jan 21, 2026
Ownership / control type
2B
Organization structure
LLCProprietary
Incorporated
Jan 1, 1987 in IL
Enrollment address
868 Mortimer
Barry, IL 62312-1249

Other NPIs with the same Medicare PAC ID 17

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 17

Other NPIs on the same Medicare enrollment 5

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
Quincy Med GRP Lewistow

Ownership & related parties

All disclosed owners & managing parties 3

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Quincy Physician Administrative Services Inc Organization, Quincy, IL Corporation, Management services company Operational/Managerial Control Dec 3, 2021
Hrishikesh P Ghanekar Individual Corporate DirectorChairman of the Board Jan 1, 2018
W-2 Managing EmployeeChairman of the Board Jan 13, 2026
Patricia a Woerman Individual W-2 Managing EmployeeCredentialing Specialist and del Aug 25, 2010

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 56

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 56

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1139788800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639958400000",
    "number": "1013981547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "868 MORTIMER ST",
            "city": "BARRY",
            "state": "IL",
            "postal_code": "623121249",
            "telephone_number": "217-335-2343"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "868 MORTIMER ST",
            "city": "BARRY",
            "state": "IL",
            "postal_code": "623121249",
            "telephone_number": "217-335-2343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC",
        "enumeration_date": "2006-02-13",
        "last_updated": "2021-12-20",
        "certification_date": "2021-12-20",
        "status": "A",
        "authorized_official_last_name": "WILLIAMSON",
        "authorized_official_first_name": "PATRICIA",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "217-222-6550",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "QUINCY MEDICAL GROUP BARRY AFFILIATE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "QUINCY MEDICAL GROUP BARRY AFFILIATE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Barry, IL

Sources for this page

Verify at the official NPI Registry.