Genesis Medical Group LLC

Primary specialty

Prosthetic/Orthotic SupplierTaxonomy code 335E00000X

Legal business name

GENESIS MEDICAL GROUP LLC

Practice address

10802 SE Washington St
Portland, OR 97216-3118

Phone

(503) 699-1911

Fax

(503) 699-1912

NPI assigned

Feb 28, 2011

Organization subpart

Yes

Parent organization

GENESIS MEDICAL GROUP, LLCAs reported in NPPES

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

Authorized official

Name

Mr. Wyatt James Brown, CPED

Title

Director of Operation

Phone

(503) 699-1911

Specialties & licenses 1

Addresses

Other identifiers 1

Tax ID family

Genesis Medical Group LLC2 organizations share this tax ID, including this one

Part of

Genesis Medical Group LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Genesis Medical Group, LLC.

  • Prosthetic/Orthotic Supplier
  • Portland, OR
  • NPI 1740538115
  NPD tax ID

Locations

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Genesis Medical Group, LLC.

  • Prosthetic/Orthotic Supplier
  • Lake Oswego, OR
  • NPI 1457517138
  NPPES parent name

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

{
    "created_epoch": "1298851200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344902400000",
    "number": "1013214014",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16679 BOONES FERRY RD STE 215",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970354368",
            "telephone_number": "503-699-1911",
            "fax_number": "503-699-1912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10802 SE WASHINGTON ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972163118",
            "telephone_number": "503-699-1911",
            "fax_number": "503-699-1912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS MEDICAL GROUP LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GENESIS MEDICAL GROUP, LLC",
        "enumeration_date": "2011-02-28",
        "last_updated": "2012-08-14",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "WYATT",
        "authorized_official_middle_name": "JAMES",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATION",
        "authorized_official_telephone_number": "503-699-1911",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CPED"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500608071",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kathleen Gendron, DPT
• Maru Genemo
• General and Vascular Surgery
• Generations Family Medicine, Professional Corporation
• Genesis Medical Group II, Inc
• Genesis Medical Group, LLC.
• Geoff Geness, D.C., LAC.
• Maryann Geness, D.C.
• Genevieve Johnson Lac LLC
• Genoa Healthcare LLC

• Prosthetic/Orthotic Supplier in Portland, OR
• Providers in Portland, OR by specialty
• Prosthetic/Orthotic Supplier in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2012; 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.