NPIMap

Organization Active NPI

Quincy Physicians & Surgeons Clinic, PLLC

Doing business as Quincy Medical Group

  • Clinical Medical Laboratory
  • Pittsfield, IL
National Provider Identifier
1639711120
Registry record updated Dec 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Medical LaboratoryTaxonomy code 291U00000X
Legal business name
QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC
Doing business as
Quincy Medical Group
Practice address
320 N Madison St
Pittsfield, IL 62363-1412
Phone
(217) 285-9601
NPI assigned
Oct 16, 2019
Last updated
Dec 20, 2021By the provider in NPPES
Organization subpart
No

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
Clinical Medical Laboratory 291U00000X NU Primary

Addresses

Primary practice location

320 N Madison St
Pittsfield, IL 62363-1412

Mailing address

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

Other names 1

  • Quincy Medical Group Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20191108002417 IL Part B Supplier - Independent Clinical Laboratory 0749192375 Practice locations: Pittsfield, IL

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

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
14D0434733Quincy Physician & Surgeons Clinic, S C320 N Madison, Pittsfield, IL 62363AccreditationJun 15, 2027

National Provider Directory

National Provider Directory
Tax ID family
Quincy Med GRP Lewistow25 organizations share this tax ID, including this one

Other organizations with this tax ID 24

Organizations that report the same tax identification number in the National Provider Directory.

View all 24

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": "1571184000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1639958400000",
    "number": "1639711120",
    "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": "320 N MADISON ST",
            "city": "PITTSFIELD",
            "state": "IL",
            "postal_code": "623631412",
            "telephone_number": "217-285-9601"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "QUINCY PHYSICIANS & SURGEONS CLINIC, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-16",
        "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": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Quincy Medical Group",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Quincy Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Pittsfield, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.