Individual provider Active NPI

Rajesh Kannan Ethiraj, M.D.,

  • Occupational Medicine Physician
  • Quincy, IL
National Provider Identifier
1669667242
Registry record updated Aug 26, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational Medicine PhysicianTaxonomy code 2083X0100X
License
036121632 Issued in IL
Practice address
927 Broadway St
Quincy, IL 62301-2719
Phone
(217) 223-6423
Fax
(217) 223-6407
NPI assigned
Sep 7, 2007
Last updated
Aug 26, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 26, 2026

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Medicine Physician 2083X0100X 036121632 IL Primary
Preventive Medicine/Occupational Environmental Medicine Physician 2083P0500X U0017 TX
Occupational Medicine Physician 2083X0100X 56255 WI

Addresses

Primary practice location

927 Broadway St
Quincy, IL 62301-2719

Mailing address

1005 Broadway St
Quincy, IL 62301-2834
Phone (217) 223-8400

Other practice location 1

3237 Voyager Dr
Green Bay, WI 54311-8349
Phone (920) 468-8288

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address rethiraj25350@blessing.medalliesdirect.net Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
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 1

Enrollment IDStateProvider typePAC IDDetails
I20260512001814 IL Order and Referring Only - Preventive MedicinePractitioner - Preventive Medicine 4082878590

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
U0017TXMDPreventive Medicine/Occupational Environmental Medicine Physician
036121632ILMDOccupational Medicine Physician
56255WIMDOccupational Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Blessing Hospital CurrentSince Aug 1, 2022 Accepting new patients
West Central Pathology Specialists, S.C. Current Accepting new patients
Blessing Hospital CurrentSince Aug 1, 2022 Accepting new patients
Quincy Clinical Laboratory Services SC Current Accepting new patients

Locations

1414 Main St
Keokuk, IA 52632
Phone (319) 524-0123

1005 Broadway St
Quincy, IL 62301

Interoperability endpoints

  • FHIR API: https://fhir.blessinghospital.com/R4/open-Prod
  • Direct secure messaging: rethiraj199520@direct.myadvocateaurora.org

Organizations & group practices 4

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

NPI Registry JSON

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

{
    "created_epoch": "1189123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1787702400000",
    "number": "1669667242",
    "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": "217-223-8400",
            "fax_number": "217-277-3960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "927 BROADWAY ST",
            "city": "QUINCY",
            "state": "IL",
            "postal_code": "623012719",
            "telephone_number": "217-223-6423",
            "fax_number": "217-223-6407"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3237 Voyager Dr",
            "address_purpose": "LOCATION",
            "city": "Green Bay",
            "state": "WI",
            "postal_code": "543118349",
            "country_code": "US",
            "telephone_number": "920-468-8288",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ETHIRAJ",
        "first_name": "RAJESH KANNAN",
        "name_prefix": "Dr.",
        "credential": "M.D.,",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-09-07",
        "last_updated": "2026-08-26",
        "certification_date": "2026-08-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "IL",
            "license": "036121632",
            "primary": true
        },
        {
            "code": "2083P0500X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Preventive Medicine/Occupational Environmental Medicine",
            "state": "TX",
            "license": "U0017",
            "primary": false
        },
        {
            "code": "2083X0100X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Occupational Medicine",
            "state": "WI",
            "license": "56255",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "rethiraj25350@blessing.medalliesdirect.net",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "927 Broadway St",
            "city": "Quincy",
            "state": "IL",
            "country_code": "US",
            "postal_code": "623012719",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Quincy, IL

Sources for this page

Verify at the official NPI Registry.