NPIMap

Organization Active NPI

Quincy Physicians & Surgeons Clinic, PLLC

Doing business as Quincy Medical Group Pittsfield Affiliate

  • Rural Health Clinic/Center
  • Pittsfield, IL
National Provider Identifier
1356315899
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 Pittsfield Affiliate
Practice address
320 North Madison
Pittsfield, IL 62363-1412
Phone
(217) 285-9601
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
Patty Woerman
Title
Credentialing Specialist
Phone
(217) 222-6550

Specialties & licenses 1

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

Addresses

Primary practice location

320 North Madison
Pittsfield, IL 62363-1412

Mailing address

320 North Madison
Pittsfield, IL 62363-1412
Phone (217) 285-9601

Other names 1

  • QUINCY MEDICAL GROUP PITTSFIELD 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…
O20101105000089 IL Part A Provider - Rural Health Clinic 0749192375 Practice locations: Pittsfield, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1356315899. Details of each certification follow.

Rural health clinic certification: CCN 143885

Legal name
QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC
Doing business as
QUINCY MEDICAL GROUP PITTSFIELD AFFILIATE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 7, 1994
Last certification
Dec 28, 2020
Ownership / control type
2B
Organization structure
LLCProprietary
Incorporated
Jan 1, 1987 in IL
Enrollment address
320 N Madison
Pittsfield, IL 62363-1412

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
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

Ownership & related parties

All disclosed owners & managing parties 2

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

NameRoleSinceShare
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 DO May 19, 2010

Owners & managing parties with NPI records 1

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

Practitioners & affiliated clinicians

Practitioners 41

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 41

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": "1356315899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "320 NORTH MADISON",
            "city": "PITTSFIELD",
            "state": "IL",
            "postal_code": "623631412",
            "telephone_number": "217-285-9601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "320 NORTH MADISON",
            "city": "PITTSFIELD",
            "state": "IL",
            "postal_code": "623631412",
            "telephone_number": "217-285-9601"
        }
    ],
    "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": "WOERMAN",
        "authorized_official_first_name": "PATTY",
        "authorized_official_title_or_position": "CREDENTIALING SPECIALIST",
        "authorized_official_telephone_number": "217-222-6550"
    },
    "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 PITTSFIELD AFFILIATE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "QUINCY MEDICAL GROUP PITTSFIELD AFFILIATE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pittsfield, IL

Sources for this page

Verify at the official NPI Registry.