NPIMap

Organization Active NPI

Genesis Medical Center, Aledo

Doing business as Genesis Health Group, Aledo

  • Clinic/Center
  • Aledo, IL
National Provider Identifier
1053664938
Registry record updated Oct 7, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
GENESIS MEDICAL CENTER, ALEDO
Doing business as
Genesis Health Group, Aledo
MercyOne Genesis Health Group Aledo
Practice address
1007 NW 3Rd St
Aledo, IL 61231-1317
Phone
(309) 582-9450
Fax
(309) 582-9479
NPI assigned
Oct 17, 2012
Last updated
Oct 7, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
GENESIS HEALTH SYSTEMAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 7, 2026

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

Authorized official

Name
Edward Rogalski
Title
Administrator
Phone
(309) 582-9250

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X IL Primary

Addresses

Primary practice location

1007 NW 3Rd St
Aledo, IL 61231-1317

Mailing address

PO Box 672128
Dallas, TX 75267-2128
Phone (309) 582-9450

Other identifiers 1

IdentifierTypeStateIssuer
07400036OtherILILLINOIS HEALTH CONNECT PRIMARY CARE PROVIDER ID NUMBER

Other names 2

  • Genesis Health Group, Aledo Doing business as
  • MercyOne Genesis Health Group Aledo Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20130124000450 IL Part A Provider - Rural Health Clinic 7315190436 Practice locations: Aledo, IL
O20130405000438 IL Part B Supplier - Clinic/Group Practice 7315190436 Receives reassigned benefits from 41 practitioners
2 other NPIs on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Aledo, IL; Woodhull, IL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1053664938. Details of each certification follow.

Rural health clinic certification: CCN 143453

Legal name
GENESIS MEDICAL CENTER, ALEDO
Doing business as
MERCYONE GENESIS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Feb 29, 2000
Last certification
Jan 3, 2020
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Feb 13, 2012 in IL
Enrollment address
1007 NW 3Rd St
Aledo, IL 61231-1317
Related CCNs
141304

Facilities connected through Provider of Services related, parent or unit certification numbers.

Other NPIs with the same Medicare PAC ID 2

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Other NPIs on the same Medicare enrollment 2

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

National Provider Directory

National Provider Directory
Part of
Genesis Health System

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 22

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Gregory J Bush Individual Corporate OfficerTreasurer Jul 24, 2003
Corporate DirectorBoard Member Jul 24, 2003
Lyn Ketelsen Individual Corporate DirectorBoard Member Jan 4, 2024
Jordan Voigt Individual Corporate OfficerPresident Jan 4, 2024
Corporate DirectorBoard Member Jan 4, 2024
Charles D Waterman Individual Corporate OfficerChair Apr 30, 2006
Corporate DirectorBoard Member Apr 30, 2006
Robert P Ritz Individual Corporate DirectorBoard Member Mar 1, 2023
Melissa C Pepper Individual Corporate OfficerSecretary Nov 1, 2019
Corporate DirectorBoard Member Nov 1, 2019
Peter Benson Individual Corporate OfficerVice Chair Sep 3, 2009
Corporate DirectorBoard Member Sep 3, 2009
Robin R Petersen Individual Corporate DirectorBoard Member Jul 29, 2004
Christopher M Crome Individual Corporate OfficerChief Operating Officer Nov 1, 2021
Lashonda Polite Individual Corporate DirectorBoard Member Nov 6, 2020
Edmund P Coyne Individual Corporate DirectorBoard Member Dec 4, 2008
Karen M Fitzsimmons Individual Corporate DirectorBoard of Directors Nov 6, 2020
Mercy Health Network Inc Organization, Clive, IA Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Indirect Ownership Interest Mar 1, 2023 100%
Genesis Health System Organization, Silvis, IL Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Feb 1, 2013 100%
Joseph Malas Individual Corporate OfficerCfo & VP Finance Jul 1, 2020
Mark C. Kilmer Individual Corporate DirectorBoard Member Sep 30, 2003
Dale D Zude Individual Corporate DirectorBoard Member Sep 25, 2001
Edwin V Motto Individual Corporate DirectorBoard Member Jul 23, 1996
Trinity Health Corporation Organization, Livonia, MI Corporation, Non-profit, Chain home office 5% Or Greater Indirect Ownership Interest Mar 1, 2023 100%
Patricia S Groves Individual Corporate DirectorBoard Member Oct 9, 2015
David Larson Individual Corporate DirectorBoard Member Mar 6, 2014
Pamela Scott Individual W-2 Managing EmployeeRevenue Integrity Administrator Jan 1, 2006

Owners & managing parties with NPI records 6

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Facilities with the same owner 215

Facilities that share an organizational owner with 5% or greater ownership or operational control.

View all 215

Practitioners & affiliated clinicians

Practitioners 18

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.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1350432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1791331200000",
    "number": "1053664938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 672128",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752672128",
            "telephone_number": "309-582-9450",
            "fax_number": "309-582-9479"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1007 NW 3RD ST",
            "city": "ALEDO",
            "state": "IL",
            "postal_code": "612311317",
            "telephone_number": "309-582-9450",
            "fax_number": "309-582-9479"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS MEDICAL CENTER, ALEDO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GENESIS HEALTH SYSTEM",
        "enumeration_date": "2012-10-17",
        "last_updated": "2026-10-07",
        "certification_date": "2026-10-07",
        "status": "A",
        "authorized_official_last_name": "ROGALSKI",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "309-582-9250"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ILLINOIS HEALTH CONNECT PRIMARY CARE PROVIDER ID NUMBER",
            "identifier": "07400036",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Genesis Health Group, Aledo",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Genesis Health Group, Aledo",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "MercyOne Genesis Health Group Aledo",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Aledo, IL

Sources for this page

Verify at the official NPI Registry.