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Genesis Health System

Organization Active NPI Clinic/Center · Bettendorf, IA

NPI 1497772008 · NPPES record last updated Jul 21, 2022

Key facts

NPI
1497772008
Entity type
Organization (NPI type 2)
Primary specialty
Clinic/Center 261Q00000X
Legal business name
GENESIS HEALTH SYSTEM
Practice address
4017 Devils Glen Rd
Bettendorf, IA 52722-7221
Phone
(563) 421-3700
Fax
(563) 421-3710
NPI assigned
Jul 17, 2006
Organization subpart
No

Authorized official

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

Owned or controlled facilities with NPI records 2

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

Other NPIs on the same Medicare enrollment 16

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

Other NPIs with the same Medicare PAC ID 10

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

Practitioners 372

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 372

Medicare participation

Medicare fee-for-service enrollment
Enrolled in IA

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 Dewitt
De Witt, IA · CCN 165619		 Skilled nursing facility 5% Or Greater Direct Ownership Interest (40%) Feb 21, 2019
The Summit of Bettendorf
Bettendorf, IA · CCN 165793		 Skilled nursing facility 5% Or Greater Direct Ownership Interest (40%) Feb 21, 2019

Medicare enrollment records

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

National Provider Directory

Specialties & licenses

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

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

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

Other names

  • GENESIS CONVENIENT CARE BETTENDORF Doing business as

Other providers in Bettendorf, IA

All providers in Bettendorf, IA · Clinic/Center in Iowa

Sources for this page

Verify at the official NPI Registry.