NPIMap

Organization Active NPI

Quincy Physicians & Surgeons Clinic, PLLC

Doing business as Quincy Medical Group

  • End-Stage Renal Disease (ESRD) Treatment Clinic/Center
  • Quincy, IL
National Provider Identifier
1053410001
Registry record updated Feb 10, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
End-Stage Renal Disease (ESRD) Treatment Clinic/CenterTaxonomy code 261QE0700X
Legal business name
QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC
Doing business as
Quincy Medical Group
Practice address
1025 Maine St
Quincy, IL 62301-4038
Phone
(217) 222-6550
Fax
(217) 277-2253
NPI assigned
Sep 22, 2006
Last updated
Feb 10, 2023By 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 Feb 10, 2023

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
End-Stage Renal Disease (ESRD) Treatment Clinic/Center 261QE0700X NU Primary

Addresses

Primary practice location

1025 Maine St
Quincy, IL 62301-4038

Mailing address

1025 Maine St
Quincy, IL 62301-4038
Phone (217) 222-6550

Other names 1

  • Quincy Medical Group Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20061018000383 IL Part A Provider - End-Stage Renal Disease Facility (ESRD) 0749192375 Practice locations: Quincy, IL

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

Care Compare: Dialysis facility

Medicare Care Compare
Listed as
Quincy Medical Group Peritoneal Dialysis CtrCCN 142680
Ownership
Profit
Certified
May 25, 2007
Medicare certification status
ActiveFrom the Provider of Services file
Dialysis stations
1

Name & address match This facility record has no NPI; it was connected to this NPI by matching name and address.

National Provider Directory

National Provider Directory
Tax ID family
Quincy Med GRP Lewistow25 organizations share this tax ID, including this one
Part of
Quincy Med GRP Lewistow

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

Practitioners & affiliated clinicians

Practitioners 1

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.

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1158883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1675987200000",
    "number": "1053410001",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1025 MAINE ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623014038",
            "telephone_number": "217-222-6550",
            "fax_number": "217-277-2253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 MAINE ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623014038",
            "telephone_number": "217-222-6550",
            "fax_number": "217-277-2253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC",
        "enumeration_date": "2006-09-22",
        "last_updated": "2023-02-10",
        "certification_date": "2023-02-10",
        "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": "261QE0700X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, End-Stage Renal Disease (ESRD) Treatment",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Quincy Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Quincy, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.