Genesis Family Practice, LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

OS8600 Issued in FL

Legal business name

GENESIS FAMILY PRACTICE, LLC

Practice address

1133 Saxon Blvd
Orange City, FL 32763-8425

Phone

(386) 228-9700

NPI assigned

Sep 27, 2012

Reactivated

Apr 17, 2018

Organization subpart

No

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

Authorized official

Name

Dr. Jay Crossette Chanmugam, D.O.NPI 1518905207

Title

Owner

Phone

(386) 878-4137

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Genesis Family Practice LLC

  • General Practice Physician
  • Ormond Beach, FL
  • NPI 1447799242

  O20130226000215

  Same enrollment

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Genesis Family Practice LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

• Genesis Family Practice LLC

  • General Practice Physician
  • Ormond Beach, FL
  • NPI 1447799242
  NPD tax ID

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Jay C Chanmugam, DO

  • Emergency Medicine Physician
  • Orange City, FL
  • NPI 1518905207
  Medicare reassignment NPD Authorized official
• Cameka Campbell

  • Family Nurse Practitioner
  • Longwood, FL
  • NPI 1043753437
  Medicare reassignment NPD
• Sylvia Collazo, MD

  • General Practice Physician
  • Kissimmee, FL
  • NPI 1063435592
  Medicare reassignment NPD
• Cesar Corretjer Russi, M.D.

  • General Practice Physician
  • The Villages, FL
  • NPI 1164619367
  Medicare reassignment NPD
• April Gustafson, APRN

  • Family Nurse Practitioner
  • Deland, FL
  • NPI 1811473275
  Medicare reassignment NPD
• Aixsa Perez, M.D.

  • General Practice Physician
  • Daytona Beach, FL
  • NPI 1639171853

  Family Medicine

  Medicare reassignment NPD

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

{
    "created_epoch": "1348704000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669593600000",
    "number": "1023369204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 SAXON BLVD",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327638425",
            "telephone_number": "386-878-4137",
            "fax_number": "386-878-4293"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1133 SAXON BLVD",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327638425",
            "telephone_number": "386-228-9700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 S Nova Rd Ste I",
            "address_purpose": "LOCATION",
            "city": "Ormond Beach",
            "state": "FL",
            "postal_code": "321747362",
            "country_code": "US",
            "telephone_number": "386-228-9700",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "GENESIS FAMILY PRACTICE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-27",
        "last_updated": "2022-11-28",
        "certification_date": "2022-11-28",
        "deactivation_date": "2018-04-09",
        "reactivation_date": "2018-04-17",
        "status": "A",
        "authorized_official_last_name": "CHANMUGAM",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "CROSSETTE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-878-4137",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.O."
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS8600",
            "primary": true
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "008488100",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Myrna A Garcia, M.D.
• Elsa F Garnica, APRN
• Gastro MD Florida, LLC
• Gastroenterology and Liver Diseases of Central Florida PA
• Alexandra Jean Geary, ARNP
• George T Besong MD OB/GYN LLC (Women's Health Resource Center)
• Edgar B George, M.D.
• Mathew K George, MD
• Georges Transport (none)
• Elize Georges

• Family Medicine Physician in Orange City, FL
• Providers in Orange City, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.