Yes
IL | 3621708404041 | 1295882561,1619466034 |
DSH140029A | Child | DSH | COPLEY MEMORIAL HOSPITAL | RUSH-COPLEY HEART INSTITUTE | 2088 OGDEN AVE | AURORA | IL | Active |
DSH140029B | Child | DSH | COPLEY MEMORIAL HOSPITAL | RUSH COPLEY CANCER CARE CLINIC YORK | 1100W VETERANS PKWY | YORKVILLE | IL | Active |
DSH140029C | Child | DSH | COPLEY MEMORIAL HOSPITAL | RUSH-COPLEY EMERGENCY CENTER - YOR | 1122W VETERANS PKWY | YORKVILLE | IL | Active |
DSH140029D | Child | DSH | COPLEY MEMORIAL HOSPITAL | ENDOCRINOLOGY - Endocrinology | 2040 OGDEN AVE | AURORA | IL | Active |
DSH140029E | Child | DSH | COPLEY MEMORIAL HOSPITAL | COPLEY MEMORIAL HOSPITAL INC - Residency Family Medicine | 2020 OGDEN AVE SUITE 330 | AURORA | IL | Active |
DSH140029F | Child | DSH | COPLEY MEMORIAL HOSPITAL | DIGESTIVE DISEASE - WATERFORD - GI Waterford | 2040 Ogden Avenue | AURORA | IL | Active |
DSH140029G | Child | DSH | COPLEY MEMORIAL HOSPITAL | CARDIOVASCULAR - HIGHLAND - CV - Highland | 1320 N HIGHLAND AVE | AURORA | IL | Active |
DSH140029H | Child | DSH | COPLEY MEMORIAL HOSPITAL | CARDIOVASCULAR - 2088 - CV - Ogden | 2088 OGDEN AVE | AURORA | IL | Active |
DSH140029J | Child | DSH | COPLEY MEMORIAL HOSPITAL | RADIATION ONCOLOGY - Radiation Oncology | 2000 OGDEN AVE | AURORA | IL | Active |
DSH140029K | Child | DSH | COPLEY MEMORIAL HOSPITAL | CARDIOVASCULAR - YORKVILLE - CV - Yorkville | 1100 W VETERANS PKWY | YORKVILLE | IL | Active |
DSH140029L | Child | DSH | COPLEY MEMORIAL HOSPITAL | ONCOLOGY - OGDEN - oncology Ogden | 2000 OGDEN AVE | AURORA | IL | Active |
DSH140029M | Child | DSH | COPLEY MEMORIAL HOSPITAL | ONCOLOGY YORKVILLE - oncology Yorkville | 1100 W VETERANS PKWY | YORKVILLE | IL | Active |
DSH140029N | Child | DSH | COPLEY MEMORIAL HOSPITAL | PULMONARY - 2088 - Pulmonary Ogden | 2040 Ogden Avenue | AURORA | IL | Active |
DSH140029P | Child | DSH | COPLEY MEMORIAL HOSPITAL | PULMONOLOGY - HIGHLAND - Pulmonary Highland | 1320 N HIGHLAND AVE | AURORA | IL | Active |
DSH140029Q | Child | DSH | COPLEY MEMORIAL HOSPITAL | ENT - ENt | 2040 Ogden Avenue | Aurora | IL | Active |
DSH140029R | Child | DSH | COPLEY MEMORIAL HOSPITAL | Urology - Urology | 2040 Ogden Avenue | Aurora | IL | Active |
Contacts | Authorizing Official | Update | AO Change Request | VanWyhe, Brenda
SENIOR VP FINANCE AND CFO
Copley Memorial Hospital
6308983565 | Schaafsma, Kate Marie
VP, Chief Pharmacy Officer
Rush University System for Health
8155924299 | 5/15/2025 6:10 AM |
Details | Last Recertification Date | Update | Recertification | 8/29/2023 10:54:12 AM | 8/29/2024 9:56:05 AM | 8/29/2024 9:56 AM |
Medicaid Billing | Medicaid: Is Primary | Insert | Recertification | | False | 8/29/2023 10:54 AM |
Medicaid Billing | Medicaid: Number | Insert | Recertification | | 3621708404041 | 8/29/2023 10:54 AM |
Medicaid Billing | Medicaid: State | Insert | Recertification | | IL | 8/29/2023 10:54 AM |
Medicaid Billing | NPI: Number | Insert | Recertification | | 1295882561 | 8/29/2023 10:54 AM |
Medicaid Billing | NPI: State | Insert | Recertification | | IL | 8/29/2023 10:54 AM |
Medicaid Billing | NPI: Number | Insert | Recertification | | 1619466034 | 8/29/2023 10:54 AM |
Medicaid Billing | NPI: State | Insert | Recertification | | IL | 8/29/2023 10:54 AM |
Details | Last Recertification Date | Update | Recertification | 8/24/2022 3:34:58 PM | 8/29/2023 10:54:12 AM | 8/29/2023 10:54 AM |
Details | Last Recertification Date | Update | Recertification | | 8/24/2022 3:34:58 PM | 8/24/2022 3:34 PM |
Details | State | Update | | Approved | Active | 7/1/2022 12:01 AM |
Contacts | Signed By | Insert | New Registration | | VanWyhe, Brenda
SENIOR VP FINANCE AND CFO
Copley Memorial Hospital
6308983565 | 4/21/2022 3:31 PM |
Details | 340B ID | Update | New Registration | | DSH140029P | 4/21/2022 3:31 PM |
Details | Entity Subname | Update | New Registration | PULMONOLOGY - HIGHLAND | PULMONOLOGY - HIGHLAND - Pulmonary Highland | 4/21/2022 3:31 PM |
Dates | Participating Approval Date | Update | New Registration | | 4/21/2022 3:31:09 PM | 4/21/2022 3:31 PM |
Details | State | Update | New Registration | Pending | Approved | 4/21/2022 3:31 PM |
Dates | Signed By Date | Update | New Registration | | 4/19/2022 5:40:23 PM | 4/21/2022 3:31 PM |
Dates | Start Date | Update | New Registration | | 7/1/2022 12:00:00 AM | 4/21/2022 3:31 PM |
Addresses | Main Address | Insert | New Registration | |
1320 N HIGHLAND AVE
STE A
AURORA, IL 60506-1468 | 4/15/2022 12:48 PM |
Contacts | Primary Contact | Insert | New Registration | | Ries, Stacey
Deputy General Counsel
Copley Memorial Hospital
6304994721 | 4/15/2022 12:48 PM |
Contacts | Authorizing Official | Insert | New Registration | | VanWyhe, Brenda
SENIOR VP FINANCE AND CFO
Copley Memorial Hospital
6308983565 | 4/15/2022 12:48 PM |
Details | Assistance Received From Date | Insert | New Registration | | | 4/15/2022 12:48 PM |
Details | Assistance Received To Date | Insert | New Registration | | | 4/15/2022 12:48 PM |
Details | Last Recertification Date | Insert | New Registration | | | 4/15/2022 12:48 PM |
Details | Grant Number | Insert | New Registration | | | 4/15/2022 12:48 PM |
Details | 340B ID | Insert | New Registration | | | 4/15/2022 12:48 PM |
Details | Is Authorizing Official EHB Data | Insert | New Registration | | | 4/15/2022 12:48 PM |
Dates | Last Date That 340B Drugs Purchased | Insert | New Registration | | | 4/15/2022 12:48 PM |
Details | Medicare Provider Number | Insert | New Registration | | 140029 | 4/15/2022 12:48 PM |
Details | Entity Name | Insert | New Registration | | COPLEY MEMORIAL HOSPITAL | 4/15/2022 12:48 PM |
Details | NOFO Number | Insert | New Registration | | | 4/15/2022 12:48 PM |
Details | Program Code | Insert | New Registration | | DSH | 4/15/2022 12:48 PM |
Details | Entity Subname | Insert | New Registration | | PULMONOLOGY - HIGHLAND | 4/15/2022 12:48 PM |
Dates | Participating Approval Date | Insert | New Registration | | | 4/15/2022 12:48 PM |
Details | State | Insert | New Registration | | Pending | 4/15/2022 12:48 PM |
Dates | Registration Date | Insert | New Registration | | 4/15/2022 12:48:23 PM | 4/15/2022 12:48 PM |
Dates | Signed By Date | Insert | New Registration | | | 4/15/2022 12:48 PM |
Dates | Start Date | Insert | New Registration | | | 4/15/2022 12:48 PM |
Terminations | Termination Comments | Insert | New Registration | | | 4/15/2022 12:48 PM |
Terminations | Termination Date | Insert | New Registration | | | 4/15/2022 12:48 PM |
Terminations | Termination Effective Date | Insert | New Registration | | | 4/15/2022 12:48 PM |
Terminations | Termination Reason | Insert | New Registration | | | 4/15/2022 12:48 PM |