Active NPI
Good Samaritan Home of Quincy
- Skilled Nursing Facility
- Quincy, IL
National Provider Identifier
1396840153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Skilled Nursing Facility
- License
- 1719820
- Legal business name
- GOOD SAMARITAN HOME OF QUINCY
- Practice address
- 2130 Harrison St
Quincy, IL 62301-6756 - Phone
- (217) 223-8717
- Fax
- (217) 223-6015
- NPI assigned
- Sep 14, 2006
- Last updated
- May 19, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Emma McLeod
- Title
- Ceo/Administrator
- Phone
- (217) 223-8717
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Custodial Care Facility | 311Z00000X | 1719820 | IL | |
| Nursing Facility/Intermediate Care Facility | 313M00000X | 1719820 | IL | |
| Skilled Nursing Facility | 314000000X | 1719820 | IL | Primary |
Addresses
Primary practice location
2130 Harrison St
Quincy, IL 62301-6756
Mailing address
2130 Harrison St
Quincy, IL 62301-6756
Phone (217) 223-8717
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IL
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100512000228 | IL | Part A Provider - Skilled Nursing Facility | 5092843037 | Practice locations: Quincy, IL |
NPI to CCN mapping 1
The Medicare certification numbers (CCNs) connected to NPI 1396840153. Details of each certification follow.
Skilled nursing facility certification: CCN 145773
- Legal name
- GOOD SAMARITAN HOME OF QUINCY
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF distinct part
- Participating since
- Mar 1, 1994
- Last certification
- Aug 15, 2024
- Beds
- 231 (203 certified)
- Ownership / control type
- Nonprofit Corporation
- Organization structure
- Corporation
- Enrollment address
- 2130 Harrison St
Quincy, IL 62301-6756 - Nursing home name
- GOOD SAMARITAN HOME
Care Compare: Nursing home
Medicare Care Compare- Listed as
- Good Samaritan Home
- Overall star rating
- Health inspections
- Staffing
- Quality measures
- Type
- Medicare and Medicaid
- Ownership
- Non profit - Corporation
- Certified
- Mar 1, 1994
- Medicare certification status
- Active
- Certified beds
- 203
- Penalties (3 years)
- 1
National Provider Directory
National Provider Directory- Tax ID family
- Good Samaritan Home of Quincy
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
-
dba Good Samaritan At Home
- In Home Supportive Care Agency
- Quincy, IL
- NPI 1356270193
Ownership & related parties
All disclosed owners & managing parties 17
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Sharon Higgins | Corporate Director | Oct 1, 2016 | |
| Managing Control - Governing Body | Oct 1, 2016 | ||
| Brian Durante | Corporate Director | Oct 1, 2022 | |
| Managing Control - Governing Body | Oct 1, 2022 | ||
| Sharon Bigelow | Corporate Officer | Oct 1, 2023 | |
| Managing Control - Governing Body | Oct 1, 2023 | ||
| Patricia Gibbs | Corporate Director | Oct 1, 2021 | |
| Managing Control - Governing Body | Oct 1, 2021 | ||
| Kelly Kern | Corporate Director | Oct 1, 2024 | |
| Managing Control - Governing Body | Oct 1, 2024 | ||
| Eric Barnes | Corporate Officer | Oct 1, 2022 | |
| Managing Control - Governing Body | Oct 1, 2022 | ||
| Gary Blickhan | Corporate Director | Oct 1, 2015 | |
| Managing Control - Governing Body | Oct 1, 2015 | ||
| Martin Gabriel | Corporate Director | Oct 1, 2021 | |
| Managing Control - Governing Body | Oct 1, 2021 | ||
| Joseph Ott | Corporate Director | Oct 1, 2019 | |
| Managing Control - Governing Body | Oct 1, 2019 | ||
| Brian Canfield | Corporate Director | Oct 1, 2022 | |
| Managing Control - Governing Body | Oct 1, 2022 | ||
| Emma McLeod | Operational/Managerial Control | Feb 22, 2022 | |
| Adp of the SNF | Feb 22, 2022 | ||
| Chris Daniels | Corporate Officer | Oct 1, 2018 | |
| Managing Control - Governing Body | Oct 1, 2018 | ||
| Steve Wavering | Corporate Director | Oct 1, 2024 | |
| Managing Control - Governing Body | Oct 1, 2024 | ||
| Randy Riley | Corporate Director | Oct 1, 2015 | |
| Managing Control - Governing Body | Oct 1, 2015 | ||
| Halley C Anderson | Operational/Managerial Control | Jun 12, 2017 | |
| Adp of the SNF | Feb 6, 2025 | ||
| Matthew Dorian | Corporate Officer | May 24, 2021 | |
| Tim White | Corporate Director | Oct 1, 2022 | |
| Managing Control - Governing Body | Oct 1, 2022 |
Owners & managing parties with NPI records 1
Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.
-
- Geriatric Medicine (Family Medicine) Physician
- Quincy, IL
- NPI 1427495803
Adp of the SNF, Operational/Managerial Control
Subparts reporting this organization as parent 1
Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.
-
dba Good Samaritan At Home
- In Home Supportive Care Agency
- Quincy, IL
- NPI 1356270193
Practitioners & affiliated clinicians
Affiliated clinicians 18
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Geriatric Medicine (Family Medicine) Physician
- Quincy, IL
- NPI 1427495803
Nursing home
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1158192000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1652918400000",
"number": "1396840153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2130 HARRISON ST",
"city": "QUINCY",
"state": "IL",
"postal_code": "623016756",
"telephone_number": "217-223-8717",
"fax_number": "217-223-6015"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2130 HARRISON ST",
"city": "QUINCY",
"state": "IL",
"postal_code": "623016756",
"telephone_number": "217-223-8717",
"fax_number": "217-223-6015"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GOOD SAMARITAN HOME OF QUINCY",
"organizational_subpart": "NO",
"enumeration_date": "2006-09-14",
"last_updated": "2022-05-19",
"certification_date": "2022-05-19",
"status": "A",
"authorized_official_last_name": "MCLEOD",
"authorized_official_first_name": "EMMA",
"authorized_official_title_or_position": "CEO/ADMINISTRATOR",
"authorized_official_telephone_number": "217-223-8717"
},
"taxonomies": [
{
"code": "311Z00000X",
"taxonomy_group": "",
"desc": "Custodial Care Facility",
"state": "IL",
"license": "1719820",
"primary": false
},
{
"code": "313M00000X",
"taxonomy_group": "",
"desc": "Nursing Facility/Intermediate Care Facility",
"state": "IL",
"license": "1719820",
"primary": false
},
{
"code": "314000000X",
"taxonomy_group": "",
"desc": "Skilled Nursing Facility",
"state": "IL",
"license": "1719820",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}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 May 19, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- 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.