NPIMap

Individual provider Active NPI

Peter John Minich, MD

  • Urology Physician
  • Quincy, IL
National Provider Identifier
1073886438
Registry record updated Mar 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
036103184 Issued in IL
Practice address
1025 Maine St
Quincy, IL 62301-4096
Phone
(217) 222-6550
NPI assigned
Feb 15, 2012
Last updated
Mar 11, 2024By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 11, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X MD00037206 WA
Urology Physician 208800000X 036103184 IL Primary

Addresses

Primary practice location

1025 Maine St
Quincy, IL 62301-4096

Mailing address

1025 Maine St
Quincy, IL 62301-4096
Phone (217) 222-6550

Other names 1

  • John Peter Minich Other name

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
I20050822000737 IL Practitioner - Urology 4981676269 Reassigns benefits to 1 organization
I20250428000275 MO Practitioner - Urology 4981676269 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Other, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Touchette Regional Hospital IncGroup PAC ID 7416843370, 46 clinicians

Practice addresses (Care Compare)

5900 Bond Ave
Cahokia Heights, IL 62207-2326
Phone (618) 332-3060

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036103184ILMDUrology Physician
MD00037206WAMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Multicare Health System Current Accepting new patients
Kirksville Clinic Corp CurrentSince Feb 3, 2025 Accepting new patients
Touchette Regional Hospital Inc CurrentSince Dec 1, 2025 Accepting new patients
Gibson Community Hospital Association Past Accepting new patients

Locations

5900 Bond Ave
East Saint Louis, IL 62207
Phone (618) 332-3060

2071 Goose Lake Rd
Sauget, IL 62206
Phone (314) 872-1473

800 W Jefferson St
Kirksville, MO 63501
Phone (660) 626-2235

Interoperability endpoints

  • Direct secure messaging: peter.minich.1@9559.direct.athenahealth.com

Organizations & group practices 4

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 5

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": "1329264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710115200000",
    "number": "1073886438",
    "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": "623014096",
            "telephone_number": "217-222-6550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 MAINE ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623014096",
            "telephone_number": "217-222-6550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MINICH",
        "first_name": "PETER",
        "middle_name": "JOHN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-02-15",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "WA",
            "license": "MD00037206",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IL",
            "license": "036103184",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JOHN",
            "last_name": "MINICH",
            "middle_name": "PETER",
            "credential": "MD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Quincy, IL

Sources for this page

Verify at the official NPI Registry.