NPIMap

Organization Active NPI

Quincy Physicians & Surgeons Clinic, PLLC

  • Rural Health Clinic/Center
  • Lewistown, MO
National Provider Identifier
1528032059
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
105 E Quincy St
Lewistown, MO 63452-2560
Phone
(573) 215-2715
NPI assigned
Feb 13, 2006
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

105 E Quincy St
Lewistown, MO 63452-2560

Mailing address

105 E Quincy St
Lewistown, MO 63452-2560
Phone (573) 215-2715

Other names 1

  • QUINCY MEDICAL GROUP LEWISTOWN AFFILIATE Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20040512000421 MO Part B Supplier - Clinic/Group Practice 0749192375 Receives reassigned benefits from 19 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Kahoka, MO; Palmyra, MO; Lewistown, MO; La Belle, MO; Canton, MO
O20101105001027 MO Part A Provider - Rural Health Clinic 0749192375 Practice locations: Lewistown, MO

Rural health clinic certification: CCN 263833

Legal name
QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC
Doing business as
QUINCY MEDICAL GROUP LEWISTOWN AFFILIATE
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Jul 19, 1994
Last certification
Oct 27, 2021
Ownership / control type
2A
Organization structure
LLCProprietary
Incorporated
Jan 1, 1987 in IL
Enrollment address
105 E Quincy Street
Lewistown, MO 63452-2560

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 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Part of
QPS Clinic SC Dbaqncy

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 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.

Facilities with the same owner 5

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

Practitioners & affiliated clinicians

Practitioners 231

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 231

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": "1528032059",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "105 E QUINCY ST",
            "city": "LEWISTOWN",
            "state": "MO",
            "postal_code": "634522560",
            "telephone_number": "573-215-2715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "105 E QUINCY ST",
            "city": "LEWISTOWN",
            "state": "MO",
            "postal_code": "634522560",
            "telephone_number": "573-215-2715"
        }
    ],
    "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": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "QUINCY MEDICAL GROUP LEWISTOWN AFFILIATE",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "QUINCY MEDICAL GROUP LEWISTOWN AFFILIATE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Lewistown, MO

Sources for this page

Verify at the official NPI Registry.