NPIMap

Organization Active NPI

Quincy Physicians & Surgeons Clinic, PLLC

  • Rural Health Clinic/Center
  • Keokuk, IA
National Provider Identifier
1508356098
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
Practice address
1603 Morgan St Ste 3
Keokuk, IA 52632-3433
Phone
(319) 524-4300
Fax
(319) 524-4424
NPI assigned
May 10, 2018
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 Primary

Addresses

Primary practice location

1603 Morgan St Ste 3
Keokuk, IA 52632-3433

Mailing address

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

Other names 1

  • Quincy Medical Group Keokuk Affiliate Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180618000840 IA Part A Provider - Rural Health Clinic 0749192375 Practice locations: Keokuk, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1508356098. Details of each certification follow.

Rural health clinic certification: CCN 168969

Legal name
QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC
Doing business as
QUINCY MEDICAL GROUP KEOKUK AFFILIATE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Oct 5, 2018
Last certification
Oct 5, 2018
Ownership / control type
1B
Organization structure
LLCProprietary
Enrollment address
1603 Morgan St
Ste 3
Keokuk, IA 52632-3433

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

National Provider Directory

National Provider Directory
Tax ID family
QP and S Clinic SC25 organizations share this tax ID, including this one
Part of
QP and S Clinic SC

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 3

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

NameRoleSinceShare
Quincy Physician Administrative Services Inc Organization, Quincy, IL Corporation, Management services company Operational/Managerial Control Dec 3, 2021 100%
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 & DO Jun 8, 2018

Owners & managing parties with NPI records 1

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

Facilities with the same owner 5

Facilities that share an organizational owner with 5% or greater ownership or operational control.

Practitioners & affiliated clinicians

Practitioners 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1525910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639958400000",
    "number": "1508356098",
    "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": "1603 MORGAN ST STE 3",
            "city": "KEOKUK",
            "state": "IA",
            "postal_code": "526323433",
            "telephone_number": "319-524-4300",
            "fax_number": "319-524-4424"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC",
        "enumeration_date": "2018-05-10",
        "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Quincy Medical Group Keokuk Affiliate",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Keokuk, IA

Sources for this page

Verify at the official NPI Registry.