Individual provider Active NPI

Robert W Weller, MD

  • Ophthalmology Physician
  • Quincy, IL
National Provider Identifier
1669445458
Registry record updated Feb 12, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
036104739 Issued in IL
Practice address
1025 Maine St
Quincy, IL 62301-4038
Phone
(217) 222-6550
NPI assigned
Feb 10, 2006
Sex
Male
Sole proprietor
No

Organizations & group practices 19

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

View all 19

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Baylor College of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Quincy Physicians and Surgeons Clinic, PLLC 231 clinicians

Practice addresses (Care Compare)

1025 Maine St
Quincy, IL 62301-4038

1450 N County Rd 2050
Carthage, IL 62321-3551
Phone (217) 357-2173

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery188

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL, MO2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100326000995 IL Practitioner - Ophthalmology 9931105780 Reassigns benefits to 1 organization
I20100830000640 MO Practitioner - Ophthalmology 9931105780 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036104739ILMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St Luke'S Methodist Hospital Current Accepting new patients
Quincy Physicians & Surgeons Clinic, PLLC CurrentSince Jul 2, 2001 Accepting new patients
Quincy Physicians & Surgeons Clinic, PLLC Ophthalmology CurrentSince Jan 1, 2002 Accepting new patients
Quincy Physicians & Surgeons Clinic, PLLC CurrentSince Jul 2, 2001 Accepting new patients

Locations

1025 Maine St
Quincy, IL 62301
Phone 21722265503163

6000 Hospital Dr
Hannibal, MO 63401
Phone (573) 248-5460

175 Shinn Ln
Hannibal, MO 63401
Phone (573) 248-0008

Interoperability endpoints

  • Direct secure messaging: rweller198200@direct.unitypoint.org

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 036104739 IL Primary

Addresses

NPPES NPI Registry

Primary practice location

1025 Maine St
Quincy, IL 62301-4038

Mailing address

1025 Maine St
Quincy, IL 62301-4038
Phone (217) 222-6550

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
036104739MedicaidIL

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Feb 12, 2010.

{
    "created_epoch": "1139529600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1265932800000",
    "number": "1669445458",
    "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": "623014038",
            "telephone_number": "217-222-6550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1025 MAINE ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623014038",
            "telephone_number": "217-222-6550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WELLER",
        "first_name": "ROBERT",
        "middle_name": "W",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-10",
        "last_updated": "2010-02-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "036104739",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036104739",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Quincy, IL

Sources for this page

Verify at the official NPI Registry.