| Details | Last Recertification Date | Update | Recertification | 1/30/2024 9:21:14 AM | 2/14/2025 10:00:39 AM | 2/14/2025 10:00 AM |
| Details | Last Recertification Date | Update | Recertification | 1/30/2023 12:12:42 PM | 1/30/2024 9:21:14 AM | 1/30/2024 9:21 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Group Change Request | | False | 8/10/2023 9:14 AM |
| Medicaid Billing | Medicaid: Number | Insert | Group Change Request | | 391919806001 | 8/10/2023 9:14 AM |
| Medicaid Billing | Medicaid: State | Insert | Group Change Request | | IL | 8/10/2023 9:14 AM |
| Medicaid Billing | NPI: Number | Insert | Group Change Request | | 1750390670 | 8/10/2023 9:14 AM |
| Medicaid Billing | NPI: State | Insert | Group Change Request | | IL | 8/10/2023 9:14 AM |
| Medicaid Billing | Medicaid: Is Primary | Insert | Change Request | | False | 6/14/2023 5:26 PM |
| Medicaid Billing | Medicaid: Number | Insert | Change Request | | 32956700 | 6/14/2023 5:26 PM |
| Medicaid Billing | Medicaid: State | Insert | Change Request | | WI | 6/14/2023 5:26 PM |
| Medicaid Billing | NPI: Number | Insert | Change Request | | 1750390670 | 6/14/2023 5:26 PM |
| Medicaid Billing | NPI: State | Insert | Change Request | | WI | 6/14/2023 5:26 PM |
| Contacts | Primary Contact | Update | Change Request | Trumpy, Brooklyn
Director Quality, Compliance & Risk
Community Health Systems, Inc.
6083133401 | Ayers, Angelique
Specialized Services Coordinator
Community Health Systems, Inc.
6082993303 | 5/16/2023 1:07 PM |
| Details | Last Recertification Date | Update | Recertification | 2/17/2022 9:42:33 AM | 1/30/2023 12:12:42 PM | 1/30/2023 12:12 PM |
| Contacts | Primary Contact | Update | Profile Change Request | Trumpy, Brooklyn
Compliance Officer
Community Health Systems, Inc.
6083133401 | Trumpy, Brooklyn
Director Quality, Compliance & Risk
Community Health Systems, Inc.
6083133401 | 10/14/2022 9:33 AM |
| Contacts | Signed By | Update | Profile Change Request | Trumpy, Brooklyn
Compliance Officer
Community Health Systems, Inc.
6083133401 | Trumpy, Brooklyn
Director Quality, Compliance & Risk
Community Health Systems, Inc.
6083133401 | 10/14/2022 9:33 AM |
| Contacts | Primary Contact | Update | Change Request | Lundvall, Mark
Director of Finance
Community Health Systems, Inc.
6083133360 | Trumpy, Brooklyn
Compliance Officer
Community Health Systems, Inc.
6083133401 | 9/29/2022 7:07 AM |
| Contacts | Signed By | Update | Change Request | Trumpy, Brooklyn
Compliance Officer
6083133401 | Trumpy, Brooklyn
Compliance Officer
Community Health Systems, Inc.
6083133401 | 9/28/2022 5:09 PM |
| Details | Last Recertification Date | Update | Recertification | 2/4/2021 10:19:03 AM | 2/17/2022 9:42:33 AM | 2/17/2022 9:42 AM |
| Details | Last Recertification Date | Update | Recertification | 2/17/2020 9:51:47 AM | 2/4/2021 10:19:03 AM | 2/4/2021 10:19 AM |
| Details | Last Recertification Date | Update | Recertification | 1/28/2019 10:16:28 AM | 2/17/2020 9:51:47 AM | 2/17/2020 9:51 AM |
| Contacts | Authorizing Official | Update | AO Change Request | SPRECHER, JULIE
CEO
Community Health Systems, Inc.
6083133362 | Davis, Caryn
Director of Finance
Community Health Systems, Inc.
6082993302 | 2/13/2020 10:17 AM |
| Contacts | Primary Contact | Update | Recertification | Amenda, Ruth
Director of Operations
Community Health Systems, Inc.
6082993309 | Lundvall, Mark
Director of Finance
Community Health Systems, Inc.
6083133360 | 1/28/2019 10:16 AM |
| Details | Last Recertification Date | Update | Recertification | 2/7/2018 11:34:32 AM | 1/28/2019 10:16:28 AM | 1/28/2019 10:16 AM |
| Contacts | Primary Contact | Update | Recertification | SPRECHER, JULIE
CEO
Community Health Systems, Inc.
6083133362 | Amenda, Ruth
Director of Operations
Community Health Systems, Inc.
6082993309 | 2/7/2018 11:34 AM |
| Details | Last Recertification Date | Update | Recertification | 2/3/2017 12:00:00 AM | 2/7/2018 11:34:32 AM | 2/7/2018 11:34 AM |
| Details | Is Authorizing Official EHB Data | Update | Recertification | False | | 2/7/2018 11:34 AM |
| Contacts | Authorizing Official | Update | | SPRECHER, JULIE
CEO
6083133362 | SPRECHER, JULIE
CEO
Community Health Systems, Inc.
6083133362 | 1/8/2018 10:36 AM |
| Contacts | Primary Contact | Update | | SPRECHER, JULIE
CEO
6083133362 | SPRECHER, JULIE
CEO
Community Health Systems, Inc.
6083133362 | 1/8/2018 10:36 AM |
| Contacts | Authorizing Official | Insert | | | SPRECHER, JULIE
CEO
6083133362 | 7/18/2017 10:37 AM |
| Contacts | Primary Contact | Insert | | | SPRECHER, JULIE
CEO
6083133362 | 7/18/2017 10:37 AM |
| Addresses | Main Address | Insert | | |
74 Eclipse Ctr
Beloit, WI 53511-3550 | 2/3/2017 3:27 PM |
| Contacts | Signed By | Insert | | | Trumpy, Brooklyn
Compliance Officer
6083133401 | 2/3/2017 3:27 PM |
| Details | Last Recertification Date | Update | | 2/12/2016 12:00:00 AM | 2/3/2017 12:00:00 AM | 2/3/2017 3:27 PM |
| Details | Last Recertification Date | Update | | | 2/12/2016 12:00:00 AM | 2/12/2016 1:42 PM |
| Dates | Participating Approval Date | Update | | | 10/19/2015 12:00:00 AM | 10/19/2015 2:59 PM |
| Details | State | Update | | Pending | Active | 10/19/2015 2:59 PM |
| Dates | Start Date | Update | | | 1/1/2016 12:00:00 AM | 10/19/2015 2:59 PM |
| Details | 340B ID | Update | | ONLINE_REG_54394 | CH05903F | 10/9/2015 3:51 PM |
| Details | 340B ID | Update | | ONLINE_REG | ONLINE_REG_54394 | 10/2/2015 3:24 PM |
| Details | Last Recertification Date | Insert | | | | 10/2/2015 3:24 PM |
| Details | Grant Number | Insert | | | H80CS00676 | 10/2/2015 3:24 PM |
| Details | 340B ID | Insert | | | ONLINE_REG | 10/2/2015 3:24 PM |
| Details | Is Authorizing Official EHB Data | Insert | | | False | 10/2/2015 3:24 PM |
| Dates | Last Date That 340B Drugs Purchased | Insert | | | | 10/2/2015 3:24 PM |
| Details | Medicare Provider Number | Insert | | | | 10/2/2015 3:24 PM |
| Details | Entity Name | Insert | | | COMMUNITY HEALTH SYSTEMS INC | 10/2/2015 3:24 PM |
| Details | Program Code | Insert | | | CH | 10/2/2015 3:24 PM |
| Details | Entity Subname | Insert | | | Beloit Area Community Health Center | 10/2/2015 3:24 PM |
| Dates | Participating Approval Date | Insert | | | | 10/2/2015 3:24 PM |
| Details | State | Insert | | | Pending | 10/2/2015 3:24 PM |
| Dates | Registration Date | Insert | | | 10/2/2015 12:00:00 AM | 10/2/2015 3:24 PM |
| Dates | Signed By Date | Insert | | | 10/2/2015 12:00:00 AM | 10/2/2015 3:24 PM |
| Dates | Start Date | Insert | | | | 10/2/2015 3:24 PM |
| Terminations | Termination Comments | Insert | | | | 10/2/2015 3:24 PM |
| Terminations | Termination Date | Insert | | | | 10/2/2015 3:24 PM |
| Terminations | Termination Effective Date | Insert | | | | 10/2/2015 3:24 PM |
| Terminations | Termination Reason | Insert | | | | 10/2/2015 3:24 PM |