Provider Demographics
NPI:1437103454
Name:GENESIS HEALTH SYSTEM
Entity Type:Organization
Organization Name:GENESIS HEALTH SYSTEM
Other - Org Name:GENESIS MEDICAL CENTER - ILLINI CAMPUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:E
Authorized Official - Last Name:BRUHN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:309-792-4265
Mailing Address - Street 1:801 ILLINI DR
Mailing Address - Street 2:
Mailing Address - City:SILVIS
Mailing Address - State:IL
Mailing Address - Zip Code:61282-1804
Mailing Address - Country:US
Mailing Address - Phone:309-792-9363
Mailing Address - Fax:563-421-3419
Practice Address - Street 1:801 ILLINI DR
Practice Address - Street 2:
Practice Address - City:SILVIS
Practice Address - State:IL
Practice Address - Zip Code:61282-1804
Practice Address - Country:US
Practice Address - Phone:309-792-9363
Practice Address - Fax:563-421-3419
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL282N00000X, 341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered282N00000XHospitalsGeneral Acute Care Hospital
Not Answered341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0715789Medicaid
IA40275OtherBLUE CROSS IA UB
005428OtherHEALTH ALLIANCE
IL0373OtherBLUE CROSS IL
A6128203OtherJDHC UB
ILCK0986OtherRR MEDICARE
IA97195OtherBLUE CROSS IA 1500 EKG
IL0811526977OtherBLUE CORSS IL 1500
IA0927640Medicaid
IA0973867Medicaid
IA96922OtherBLUE CROSS 1500 ED
ILCK0986OtherRR MEDICARE
IL=========001Medicaid
IA40275OtherBLUE CROSS IA UB
IL=========003Medicaid
IA0715789Medicaid
IA0927640Medicaid
IL813810Medicare ID - Type UnspecifiedMEDICARE PART B MULIT
IA140275Medicare Oscar/Certification