NPIMap

Individual provider Active NPI

Wissam Derian, MD

  • Cardiovascular Disease Physician
  • Quincy, IL
National Provider Identifier
1063684066
Registry record updated Feb 8, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
036113096 Issued in IL
Practice address
1025 Maine St
Quincy, IL 62301-4038
Phone
(217) 222-6550
Fax
(217) 277-2253
NPI assigned
Mar 31, 2008
Last updated
Feb 8, 2010By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 036113096 IL 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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20080813000839 IL Practitioner - Internal MedicinePractitioner - Cardiovascular Disease (Cardiology) 9234204082 Reassigns benefits to 3 organizations
I20241218000470 MO Practitioner - Cardiovascular Disease (Cardiology) 9234204082 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Internal MedicineAlso: Cardiovascular Disease (Cardiology)
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Pike County Memorial HospitalGroup PAC ID 8123015518, 31 clinicians

Practice addresses (Care Compare)

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

1025 Maine St
Quincy, IL 62301-4096

1450 N County Rd 2050
Carthage, IL 62321-3551
Phone (217) 357-2173

216 Pittsfield Rd
Mt Sterling, IL 62353-1626
Phone (217) 773-3963

2305 Georgia St
Louisiana, MO 63353-2559
Phone (573) 754-5531

3301 Broadway St
Quincy, IL 62301-3713
Phone (217) 277-3500

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair32

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036113096ILMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke's Methodist Hospital Current Accepting new patients
Pike County Memorial Hospital CurrentSince Jan 2, 2025 Accepting new patients
Pike County Memorial Hospital Current Accepting new patients
Memorial Hospital Association Current Accepting new patients
Pike County Memorial Hospital CurrentSince Jan 2, 2025 Accepting new patients
Quincy Physicians & Surgeons Clinic, PLLC CurrentSince Jul 20, 2008 Accepting new patients
Memorial Hospital Association CurrentSince Nov 1, 2020 Accepting new patients
Memorial Hospital Association CurrentSince Nov 1, 2020 Accepting new patients
Quincy Physicians & Surgeons Clinic, PLLC CurrentSince Jul 20, 2008 Accepting new patients
Pike County Memorial Hospital Past Accepting new patients

Locations

1450 N County Road 2050 E
Carthage, IL 62321
Phone (217) 357-2173

1454 N County Road 2050 E
Carthage, IL 62321
Phone (217) 357-3131

1025 Maine St
Quincy, IL 62301
Phone 21722265503163

2305 Georgia St
Louisiana, MO 63353
Phone (573) 754-4584

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/89787a16-eaf7-491e-bab0-d804157796a5/
  • Direct secure messaging: wderian198106@direct.unitypoint.org

Organizations & group practices 10

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1206921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265587200000",
    "number": "1063684066",
    "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": {
        "last_name": "DERIAN",
        "first_name": "WISSAM",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-03-31",
        "last_updated": "2010-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036113096",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, IL

Sources for this page

Verify at the official NPI Registry.