NPIMap

Individual provider Active NPI

Glenda M Gensolin, MD

  • Family Medicine Physician
  • Niles, MI
National Provider Identifier
1033195748
Registry record updated Mar 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301090975 Issued in MI
Practice address
24 N Saint Joseph Ave Ste C2
Niles, MI 49120-2263
Phone
(269) 683-0330
Fax
(269) 684-0400
NPI assigned
Dec 15, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 10, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35068802G OH
Family Medicine Physician 207Q00000X 4301090975 MI Primary

Addresses

Primary practice location

24 N Saint Joseph Ave Ste C2
Niles, MI 49120-2263

Mailing address

24 N Saint Joseph Ave Ste C2
Niles, MI 49120-2263
Phone (269) 683-0330

Other identifiers 1

IdentifierTypeStateIssuer
1437343373OtherMIGROUP NPI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190508001087 TX Practitioner - Family Practice 3274620349 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1979
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Eagle Butte Indian Health Service HospitalGroup PAC ID 7517852759, 42 clinicians

Practice addresses (Care Compare)

24276 166TH Airport Rd
Eagle Butte, SD 57625-1022
Phone 60596477240515

PO Box
Suite 1012
Eagle Butte, SD 57625-1012

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35068802GOHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Eagle Butte Indian Health Service Hospital CurrentSince Mar 18, 2019 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

Hospital & facility affiliations 14

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 14

NPI Registry JSON

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

{
    "created_epoch": "1134604800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1394409600000",
    "number": "1033195748",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "24 N SAINT JOSEPH AVE STE C2",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491202263",
            "telephone_number": "269-683-0330",
            "fax_number": "269-684-0400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24 N SAINT JOSEPH AVE STE C2",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491202263",
            "telephone_number": "269-683-0330",
            "fax_number": "269-684-0400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENSOLIN",
        "first_name": "GLENDA",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-12-15",
        "last_updated": "2014-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35068802G",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301090975",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP NPI",
            "identifier": "1437343373",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Niles, MI

Sources for this page

Verify at the official NPI Registry.