NPIMap

Organization Active NPI

Genesis Health System

Doing business as Genesis Medical Center Dewitt

  • Critical Access Hospital
  • De Witt, IA
National Provider Identifier
1407938269
Registry record updated Jul 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Critical Access HospitalTaxonomy code 282NC0060X
Legal business name
GENESIS HEALTH SYSTEM
Doing business as
Genesis Medical Center Dewitt
Practice address
1118 11TH St
De Witt, IA 52742-1235
Phone
(563) 659-4200
Fax
(563) 421-3419
NPI assigned
Oct 20, 2006
Last updated
Jul 9, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 9, 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
(563) 659-4220

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Medicare Defined Swing Bed Hospital Unit 275N00000X IA
Critical Access Hospital 282NC0060X IA Primary

Addresses

Primary practice location

1118 11TH St
De Witt, IA 52742-1235

Mailing address

1118 11TH St
De Witt, IA 52742-1353
Phone (563) 659-4200

Other identifiers 1

IdentifierTypeStateIssuer
66062OtherIABC OF IOWA SKILLED

Other names 1

  • Genesis Medical Center Dewitt Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070205000092 IA Part A Provider - Critical Access Hospital 7214841436 Practice locations: De Witt, IA

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1407938269. Details of each certification follow.

Hospital certification: CCN 16Z313

Legal name
GENESIS HEALTH SYSTEM
Doing business as
MERCYONE GENESIS DEWITT MEDICAL CENTER
Organization structure
CorporationNon-profit
Enrollment address
1118 11TH St
De Witt, IA 52742-1353
Hospital Swing-Bed Unit

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

Other NPIs with the same Medicare PAC ID 10

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

National Provider Directory

National Provider Directory
Tax ID family
Dav Med37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

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

View all 36

Ownership & related parties

All disclosed owners & managing parties 20

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

NameRoleSinceShare
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 Member Nov 6, 2020
Mercy Health Network Inc Organization, Clive, IA Corporation, Non-profit, Owned by another organization or individual 5% Or Greater Direct Ownership Interest Mar 1, 2023 100%
Joseph Malas Individual Corporate OfficerCfo & VP Finance Jul 1, 2020
Mark C. Kilmer Individual Corporate DirectorBord Member Sep 30, 2003
Dale D Zude Individual Corporate OfficerTreasurer Jan 1, 2025
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 4

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

All facility ownership & control disclosures 2

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Fieldstone of DewittDe Witt, IA, CCN 165619 Skilled nursing facility 5% Or Greater Direct Ownership Interest (40%) Feb 21, 2019
The Summit of BettendorfBettendorf, IA, CCN 165793 Skilled nursing facility 5% Or Greater Direct Ownership Interest (40%) Feb 21, 2019

Owned or controlled facilities with NPI records 2

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

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 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.

Affiliated clinicians 6

Clinicians who list this facility as an affiliation in Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1161302400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1783555200000",
    "number": "1407938269",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1118 11TH ST",
            "city": "DE WITT",
            "state": "IA",
            "postal_code": "527421353",
            "telephone_number": "563-659-4200",
            "fax_number": "563-421-3419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1118 11TH ST",
            "city": "DE WITT",
            "state": "IA",
            "postal_code": "527421235",
            "telephone_number": "563-659-4200",
            "fax_number": "563-421-3419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-20",
        "last_updated": "2026-07-09",
        "certification_date": "2026-07-09",
        "status": "A",
        "authorized_official_last_name": "ROGALSKI",
        "authorized_official_first_name": "EDWARD",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "563-659-4220"
    },
    "taxonomies": [
        {
            "code": "275N00000X",
            "taxonomy_group": "",
            "desc": "Medicare Defined Swing Bed Unit",
            "state": "IA",
            "license": null,
            "primary": false
        },
        {
            "code": "282NC0060X",
            "taxonomy_group": "",
            "desc": "General Acute Care Hospital, Critical Access",
            "state": "IA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC OF IOWA SKILLED",
            "identifier": "66062",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Genesis Medical Center Dewitt",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in De Witt, IA

Sources for this page

Verify at the official NPI Registry.