NPIMap

Organization Active NPI

Genesis Health System

Doing business as Genesis Convenient Care Bettendorf

  • Clinic/Center
  • Bettendorf, IA
National Provider Identifier
1497772008
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
GENESIS HEALTH SYSTEM
Doing business as
Genesis Convenient Care Bettendorf
Practice address
4017 Devils Glen Rd
Bettendorf, IA 52722-7221
Phone
(563) 421-3700
Fax
(563) 421-3710
NPI assigned
Jul 17, 2006
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Mr. Mark G Rogers
Title
Interim Cfo
Phone
(563) 421-6513

Specialties & licenses 1

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

Addresses

Primary practice location

4017 Devils Glen Rd
Bettendorf, IA 52722-7221

Mailing address

PO Box 765
East Moline, IL 61244-0765
Phone (563) 355-9200

Other identifiers 6

IdentifierTypeStateIssuer
08753OtherIABLUE CROSS/BLUE SHIELD IA
660022OtherHEALTH ALLIANCE
2243972MedicaidIA
387175OtherHEALTHLINK
IA0100OtherJDHC
616351OtherHARVARD PILGRIM

Other names 1

  • GENESIS CONVENIENT CARE BETTENDORF Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20031113000044 IA Part B Supplier - Clinic/Group Practice 7214841436 Receives reassigned benefits from 306 practitioners
16 other NPIs on this enrollment
Practice locations: Bettendorf, IA; Davenport, IA; Eldridge, IA; Durant, IA; De Witt, IA

Other NPIs with the same Medicare PAC ID 10

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

Other NPIs on the same Medicare enrollment 16

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

View all 16

National Provider Directory

National Provider Directory

Ownership & related parties

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.

Practitioners & affiliated clinicians

Practitioners 342

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 342

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1497772008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 765",
            "city": "EAST MOLINE",
            "state": "IL",
            "postal_code": "612440765",
            "telephone_number": "563-355-9200",
            "fax_number": "563-355-3419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4017 DEVILS GLEN RD",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527227221",
            "telephone_number": "563-421-3700",
            "fax_number": "563-421-3710"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-17",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "ROGERS",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "INTERIM  CFO",
        "authorized_official_telephone_number": "563-421-6513",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "IA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS/BLUE SHIELD IA",
            "identifier": "08753",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH ALLIANCE",
            "identifier": "660022",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2243972",
            "state": "IA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHLINK",
            "identifier": "387175",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JDHC",
            "identifier": "IA0100",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HARVARD PILGRIM",
            "identifier": "616351",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GENESIS CONVENIENT CARE BETTENDORF",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bettendorf, IA

Sources for this page

Verify at the official NPI Registry.