Genesis Health System

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

GENESIS HEALTH SYSTEM

Practice address

205 11TH St
Port Byron, IL 61275-9037

Phone

(309) 523-3116

Fax

(309) 523-3916

NPI assigned

Aug 21, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Mark J Kleinschmidt

Title

Vice President of Finance

Phone

(563) 421-6513

Specialties & licenses 1

Addresses

Other names 1

• Genesis Health Group Doing business as

Locations

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1770699043",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "865 LINCOLN RD",
            "address_2": "SUITE L10",
            "city": "BETTENDORF",
            "state": "IA",
            "postal_code": "527224190",
            "telephone_number": "563-355-9191",
            "fax_number": "563-355-3419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 11TH ST",
            "city": "PORT BYRON",
            "state": "IL",
            "postal_code": "612759037",
            "telephone_number": "309-523-3116",
            "fax_number": "309-523-3916"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS HEALTH SYSTEM",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-21",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KLEINSCHMIDT",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "VICE PRESIDENT OF FINANCE",
        "authorized_official_telephone_number": "563-421-6513",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Genesis Health Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• David Lee Bull, DC
• Peter D Crocker, D.C.
• Sydney Christine Delgadillo, DMD
• Family Physical Therapy, LLC
• Galva Family Dentistry, Inc.
• Barbara Ann Gillman, DT
• Gregory L Glade, DMD
• Sarah Lynn Goodson, LCSW
• Gregory L Glade DMD PC
• Abigail Martina Johnson, ATC

• All providers in Port Byron, IL
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.