Individual provider Active NPI

Todd R Porter, MD

  • Pediatrics Physician
  • Quincy, IL
National Provider Identifier
1407931140
Registry record updated Aug 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036158039 Issued in IL
Practice address
1025 Maine St
Quincy, IL 62301-4096
Phone
(217) 222-6550
NPI assigned
Oct 25, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 40048 CO
Pediatrics Physician 208000000X 036158039 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 identifiers 1

IdentifierTypeStateIssuer
53170580MedicaidCO

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address tporter21639@direct.dhha.org Health Information Exchange (HIE)

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20211008001039 IL Practitioner - Pediatric Medicine 4082665260 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
University of Virginia School of Medicine, 2000
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

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

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
40048COMDPediatrics Physician
036158039ILMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Quincy Physicians & Surgeons Clinic, PLLC CurrentSince Sep 20, 2021 Accepting new patients
St Luke'S Methodist Hospital Current Accepting new patients
Quincy Physicians & Surgeons Clinic, PLLC CurrentSince Sep 20, 2021 Accepting new patients
Quincy Physicians & Surgeons Clinic, PLLC Past Accepting new patients

Locations

1025 Maine St
Quincy, IL 62301
Phone 21722265503163

Interoperability endpoints

  • Direct secure messaging: tporter21639@direct.dhha.org
  • Direct secure messaging: tporter834591@direct.unitypoint.org

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1161734400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1629763200000",
    "number": "1407931140",
    "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": "PORTER",
        "first_name": "TODD",
        "middle_name": "R",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-25",
        "last_updated": "2021-08-24",
        "certification_date": "2021-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CO",
            "license": "40048",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036158039",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "53170580",
            "state": "CO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "tporter21639@direct.dhha.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "777 Bannock St",
            "city": "Denver",
            "state": "CO",
            "country_code": "US",
            "postal_code": "802044507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Quincy, IL

Sources for this page

Verify at the official NPI Registry.