Wayland J Mutter, RN
Individual provider Active NPI Nurse Practitioner · Quincy, IL
NPI 1447769724 · NPPES record last updated Mar 22, 2018
Key facts
- NPI
- 1447769724
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Nurse Practitioner 363L00000X
- License
- 209017279 (IL)
- Practice address
- 1005 Broadway St
Quincy, IL 62301-2834 - Phone
- (217) 223-1200
- NPI assigned
- Sep 29, 2017
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 25
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2017
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Blessing Hospital
Practice addresses (Care Compare)
1005 Broadway St
Quincy, IL 62301-2834
Phone (217) 223-8400
Hospital & facility affiliations
- Blessing Hospital
- Memorial Hospital
- Hannibal Regional Hospital
- MC Donough District Hospital
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20180320001919 | IL | Practitioner - Nurse Practitioner | 3476815010 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Certified Nurse Practitioner, Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 041326848 | IL | MD | Critical Care Medicine Registered Nurse |
| 209017279 | IL | MD | Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Blessing Hospital | Current |
Accepting new patients | |
| Quincy Physicians & Surgeons Clinic, PLLC | Current |
Accepting new patients | |
| Quincy Physicians & Surgeons Clinic, PLLC | Current | Accepting new patients | |
| Blessing Hospital | Current |
Accepting new patients | |
| Quincy Physicians & Surgeons Clinic, PLLC | Nurse Practitioner | Current |
Accepting new patients |
| St Luke'S Methodist Hospital | Current | Accepting new patients |
Locations
1005 Broadway St
Quincy, IL 62301
1025 Maine St
Quincy, IL 62301
Phone 21722265503163
Interoperability endpoints
- wmutter610360@direct.unitypoint.org
- https://fhir.blessinghospital.com/R4/open-Prod
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Critical Care Medicine Registered Nurse | 163WC0200X | 041326848 | IL | |
| Nurse Practitioner | 363L00000X | 209017279 | IL | Yes |
Addresses
Primary practice location
1005 Broadway St
Quincy, IL 62301-2834
Mailing address
1025 Maine St
Quincy, IL 62301-4038
Phone (217) 222-6550
Other providers in Quincy, IL
- Lori Ann Murphy
- Tracy Douglas Murphy
- Carolyn Musholt
- Adnan Mushtaq
- Michael R. Mustard
- Arshad R Muzaffar
- Cheyenne Noelle Myers
- Kirsten V Myers Sr.
- Michael G Myers
- Sangeetha Nadarajah
All providers in Quincy, IL · Nurse Practitioner in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 22, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.