NPIMap

Individual provider Active NPI

Quincy O Scott, D.O.

  • Family Medicine Physician
  • Carbondale, IL
National Provider Identifier
1992781710
Registry record updated Dec 28, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
036-084940 Issued in IL
Practice address
305 W Jackson St
Suite 200
Carbondale, IL 62901-1474
Phone
(618) 536-6621
Fax
(618) 453-1102
NPI assigned
Dec 22, 2005
Last updated
Dec 28, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 036-084940 IL Primary

Addresses

Primary practice location

305 W Jackson St
Suite 200
Carbondale, IL 62901-1474

Mailing address

305 W Jackson St
Suite 200
Carbondale, IL 62901-1474
Phone (618) 536-6621

Other practice location 1

2553 Ken Gray Blvd
West Frankfort, IL 62896-4174
Phone (618) 932-3937

Other identifiers 1

IdentifierTypeStateIssuer
036084940MedicaidIL

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address quincyscott@siusm.allscriptsdirect.net
Direct Messaging Address qscott15462@sih.direct-ci.com

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20100610000772 IL Practitioner - Family Practice 4587794946 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Midwestern University, Chicago College of Osteopathic Med, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians

Practice addresses (Care Compare)

2421 W Main St
Suite a
Carbondale, IL 62901-1039
Phone (618) 529-3201

300 W Oak St
Carbondale, IL 62901-1400
Phone (618) 536-6621

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-084940ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Illinois Hospital Services Family Medicine CurrentSince Feb 13, 2018 Accepting new patients
Siu Physicians & Surgeons, Inc CurrentSince Nov 22, 2016 Accepting new patients
Board of Trustees of Southern Illinois University Current Accepting new patients
Board of Trustees of Southern Illinois University Family Medicine CurrentSince Jan 7, 2021 Accepting new patients
Southern Illinois Hospital Services Current Accepting new patients
Siu Physicians & Surgeons, Inc Family Medicine CurrentSince Nov 22, 2016 Accepting new patients
Board of Trustees of Southern Illinois University CurrentSince Jan 7, 2021 Accepting new patients
Southern Illinois Hospital Services CurrentSince Feb 13, 2018 Accepting new patients
Southern Illinois University Past Accepting new patients

Locations

305 W Jackson St
Ste 200
Carbondale, IL 62901
Phone (618) 453-3777

520 N 4th St
Springfield, IL 62702
Phone (217) 757-8100

751 N Rutledge St
Springfield, IL 62702
Phone (217) 545-0182

2553 Ken Gray Blvd
West Frankfort, IL 62896
Phone (618) 932-2155

Organizations & group practices 9

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1135209600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609113600000",
    "number": "1992781710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 W JACKSON ST",
            "address_2": "SUITE 200",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011474",
            "telephone_number": "618-536-6621",
            "fax_number": "618-453-1102"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 W JACKSON ST",
            "address_2": "SUITE 200",
            "city": "CARBONDALE",
            "state": "IL",
            "postal_code": "629011474",
            "telephone_number": "618-536-6621",
            "fax_number": "618-453-1102"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2553 Ken Gray Blvd",
            "address_purpose": "LOCATION",
            "city": "West Frankfort",
            "state": "IL",
            "postal_code": "628964174",
            "country_code": "US",
            "telephone_number": "618-932-3937",
            "fax_number": "618-932-2734",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "SCOTT",
        "first_name": "QUINCY",
        "middle_name": "O",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-22",
        "last_updated": "2020-12-28",
        "certification_date": "2020-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036-084940",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036084940",
            "state": "IL"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "quincyscott@siusm.allscriptsdirect.net",
            "affiliation": "N",
            "address_1": "305 W Jackson St",
            "address_2": "Suite 200",
            "city": "Carbondale",
            "state": "IL",
            "country_code": "US",
            "postal_code": "629011474",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "qscott15462@sih.direct-ci.com",
            "affiliation": "N",
            "address_1": "2553 Ken Gray Blvd",
            "city": "West Frankfort",
            "state": "IL",
            "country_code": "US",
            "postal_code": "628964174",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Carbondale, IL

Sources for this page

Verify at the official NPI Registry.