| Details | Last Recertification Date | Update | Recertification | 2/1/2024 10:37:31 AM | 2/12/2025 9:48:44 AM | 2/12/2025 9:48 AM |
| Details | Last Recertification Date | Update | Recertification | 2/2/2023 9:39:26 AM | 2/1/2024 10:37:31 AM | 2/1/2024 10:37 AM |
| Contacts | Authorizing Official | Update | Change Request | Bernstein, Frederick
CEO
Community Health & Emergency Services, Inc.
6184570450-3901 | Houston, Kanci
CEO
Community Health & Emergency Services, Inc.
6184570450 | 1/8/2024 12:15 PM |
| Details | Last Recertification Date | Update | Recertification | 1/31/2022 12:14:25 PM | 2/2/2023 9:39:26 AM | 2/2/2023 9:39 AM |
| Details | Last Recertification Date | Update | Recertification | 2/2/2021 5:27:47 PM | 1/31/2022 12:14:25 PM | 1/31/2022 12:14 PM |
| Medicaid Billing | Medicaid: Number | Delete | Recertification | 371100482012 (IL) | | 2/2/2021 5:27 PM |
| Medicaid Billing | NPI: Number | Delete | Recertification | 1710979588 ( ) | | 2/2/2021 5:27 PM |
| Details | Last Recertification Date | Update | Recertification | 1/29/2020 10:05:35 AM | 2/2/2021 5:27:47 PM | 2/2/2021 5:27 PM |
| Details | Last Recertification Date | Update | Recertification | 2/7/2019 3:34:40 PM | 1/29/2020 10:05:35 AM | 1/29/2020 10:05 AM |
| Details | Last Recertification Date | Update | Recertification | 2/8/2018 10:10:08 AM | 2/7/2019 3:34:40 PM | 2/7/2019 3:34 PM |
| Contacts | Authorizing Official | Update | Profile Change Request | BERNSTEIN, FREDERICK
CEO
Community Health & Emergency Services, Inc.
6184570450-3901 | Bernstein, Frederick
CEO
Community Health & Emergency Services, Inc.
6184570450-3901 | 2/8/2018 10:12 AM |
| Contacts | Primary Contact | Update | Recertification | BERNSTEIN, FREDERICK
CEO
Community Health & Emergency Services, Inc.
6184570450-3901 | Turner, Suzanne
Director of Human Resources
Community Health & Emergency Services, Inc.
6184570450-3903 | 2/8/2018 10:10 AM |
| Details | Last Recertification Date | Update | Recertification | 2/21/2017 12:00:00 AM | 2/8/2018 10:10:08 AM | 2/8/2018 10:10 AM |
| Contacts | Authorizing Official | Update | | BERNSTEIN, FREDERICK
CEO
6184570450-3901 | BERNSTEIN, FREDERICK
CEO
Community Health & Emergency Services, Inc.
6184570450-3901 | 1/16/2018 4:47 PM |
| Contacts | Primary Contact | Update | | BERNSTEIN, FREDERICK
CEO
6184570450-3901 | BERNSTEIN, FREDERICK
CEO
Community Health & Emergency Services, Inc.
6184570450-3901 | 1/16/2018 4:47 PM |
| Contacts | Authorizing Official | Insert | | | BERNSTEIN, FREDERICK
CEO
6184570450-3901 | 7/10/2017 11:53 AM |
| Contacts | Primary Contact | Insert | | | BERNSTEIN, FREDERICK
CEO
6184570450-3901 | 7/10/2017 11:53 AM |
| Addresses | Main Address | Insert | | |
226 MAIN STREET
ROSICLARE, IL 62982-0069 | 2/21/2017 12:47 PM |
| Details | Last Recertification Date | Update | | 3/7/2016 12:00:00 AM | 2/21/2017 12:00:00 AM | 2/21/2017 12:47 PM |
| Details | Last Recertification Date | Update | | 3/10/2015 12:00:00 AM | 3/7/2016 12:00:00 AM | 3/7/2016 2:45 PM |
| Details | Last Recertification Date | Update | | 3/15/2014 12:00:00 AM | 3/10/2015 12:00:00 AM | 3/10/2015 10:35 AM |
| Details | Last Recertification Date | Update | | 4/1/2013 12:00:00 AM | 3/15/2014 12:00:00 AM | 3/15/2014 5:32 AM |
| Details | Entity Name | Update | | COMMUNITY HEALTH & EMERGENCY SERVICES, INC. | COMMUNITY HEALTH & EMERGENCY SERVICES, INC | 3/15/2014 5:32 AM |
| Addresses | Billing Address | Insert | | | COMMUNITY HEALTH & EMERGENCY SERVICES, INC.
148 EAST PLEASANT HILL ROAD
ONE ENTERPRISE PLACE, SUITE 107
CARBONDALE, IL 62903 | 3/20/2013 10:00 AM |
| Addresses | Billing Address | Update | | COMMUNITY HEALTH & EMERGENCY SERVICES, INC.
148 EAST PLEASANT HILL ROAD
ONE ENTERPRISE PLACE, SUITE 107
CARBONDALE, IL 62903 | COMMUNITY HEALTH & EMERGENCY SERVICES, INC.
PO Box 3008
CARBONDALE, IL 62902-3008 | 3/20/2013 10:00 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | | | False | 3/20/2013 10:00 AM |
| Medicaid Billing | Medicaid: Number | Insert | | | 371100482012 | 3/20/2013 10:00 AM |
| Medicaid Billing | Medicaid: State | Insert | | | IL | 3/20/2013 10:00 AM |
| Medicaid Billing | NPI: Number | Insert | | | 1710979588 | 3/20/2013 10:00 AM |
| Details | Last Recertification Date | Update | | | 4/1/2013 12:00:00 AM | 3/20/2013 10:00 AM |
| Details | Last Recertification Date | Insert | | | | 12/22/2009 8:24 AM |
| Details | Grant Number | Insert | | | H80CS00680 | 12/22/2009 8:24 AM |
| Details | 340B ID | Insert | | | CHC00680-07 | 12/22/2009 8:24 AM |
| Details | Is Authorizing Official EHB Data | Insert | | | | 12/22/2009 8:24 AM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 12/22/2009 8:24 AM |
| Details | Medicare Provider Number | Insert | | | | 12/22/2009 8:24 AM |
| Details | Entity Name | Insert | | | COMMUNITY HEALTH & EMERGENCY SERVICES, INC. | 12/22/2009 8:24 AM |
| Details | Program Code | Insert | | | CH | 12/22/2009 8:24 AM |
| Details | Entity Subname | Insert | | | HARDIN COUNTY DENTAL CLINIC | 12/22/2009 8:24 AM |
| Dates | Participating Approval Date | Insert | | | 12/4/2009 12:00:00 AM | 12/22/2009 8:24 AM |
| Details | State | Insert | | | Active | 12/22/2009 8:24 AM |
| Dates | Registration Date | Insert | | | 12/4/2009 12:00:00 AM | 12/22/2009 8:24 AM |
| Dates | Signed By Date | Insert | | | 10/30/2009 12:00:00 AM | 12/22/2009 8:24 AM |
| Dates | Start Date | Insert | | | 1/1/2010 12:00:00 AM | 12/22/2009 8:24 AM |
| Terminations | Termination Comments | Insert | | | | 12/22/2009 8:24 AM |
| Terminations | Termination Date | Insert | | | | 12/22/2009 8:24 AM |
| Terminations | Termination Effective Date | Insert | | | | 12/22/2009 8:24 AM |
| Terminations | Termination Reason | Insert | | | | 12/22/2009 8:24 AM |