NPIMap

Organization Active NPI

Blessing Hospital

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Quincy, IL
National Provider Identifier
1629148127
Registry record updated Nov 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
Legal business name
BLESSING HOSPITAL
Practice address
927 Broadway St
Suite 205
Quincy, IL 62301-2719
Phone
(217) 277-8960
Fax
(217) 223-4692
NPI assigned
Nov 9, 2006
Organization subpart
Yes
Parent organization
BLESSING HOSPITALAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 27, 2023

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

Authorized official

Name
Mr. Timothy A Moore
Title
Cao
Phone
(217) 223-1200

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208G00000X Primary

Addresses

Primary practice location

927 Broadway St
Suite 205
Quincy, IL 62301-2719

Mailing address

1005 Broadway St
Quincy, IL 62301-2834
Phone (217) 277-8960

Other names 1

  • Quincy Cardiothoracic Specialists Other name

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040330001155 IL Part B Supplier - Clinic/Group Practice 3072422534 Receives reassigned benefits from 120 practitioners
6 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Golden, IL; Quincy, IL

Other NPIs on the same Medicare enrollment 5

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

National Provider Directory

National Provider Directory
Part of
Blessing Hosp Cardiolog

Locations

927 Broadway St
Ste 205
Quincy, IL 62301
Phone (217) 277-8960

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1163030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1701043200000",
    "number": "1629148127",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1005 BROADWAY ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623012834",
            "telephone_number": "217-277-8960",
            "fax_number": "217-223-4692"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "927 BROADWAY ST",
            "address_2": "SUITE 205",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623012719",
            "telephone_number": "217-277-8960",
            "fax_number": "217-223-4692"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLESSING HOSPITAL",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "BLESSING HOSPITAL",
        "enumeration_date": "2006-11-09",
        "last_updated": "2023-11-27",
        "certification_date": "2020-03-06",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "TIMOTHY",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "CAO",
        "authorized_official_telephone_number": "217-223-1200",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "208G00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://cobiusconnect.cobius.com:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.1068.1",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "2720 Dundee Rd # 302",
            "city": "Northbrook",
            "state": "IL",
            "country_code": "US",
            "postal_code": "600622609",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Quincy Cardiothoracic Specialists",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Quincy Cardiothoracic Specialists",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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 Nov 27, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.