NPIMap

Organization Active NPI

Genesis Eldercare Physician Services LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Louisville, KY
National Provider Identifier
1033535828
Registry record updated Aug 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
Legal business name
GENESIS ELDERCARE PHYSICIAN SERVICES LLC
Practice address
16605 Chestnut Glen PL
Louisville, KY 40245
Phone
(410) 543-1957
NPI assigned
Mar 17, 2014
Last updated
Aug 5, 2019By the provider in NPPES
Organization subpart
Yes
Parent organization
GENESIS HEALTHCARE, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 5, 2019

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

Authorized official

Name
Eric Shapiro
Title
Vice President
Phone
(410) 832-7790

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0300X Primary
Adult Health Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LA2200X 0858289.09 KY

Addresses

Primary practice location

16605 Chestnut Glen PL
Louisville, KY 40245

Mailing address

PO Box 62946
Baltimore, MD 21264-2946
Phone (410) 494-7607

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20140821002540 KY Part B Supplier - Clinic/Group Practice 9830002534 Receives reassigned benefits from 1 practitioner
Practice locations: Woodburn, KY; Williamstown, KY; Shelbyville, KY; Paducah, KY; Owenton, KY; Owensboro, KY; Madisonville, KY; Louisville, KY…

Other NPIs with the same Medicare PAC ID 14

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 14

National Provider Directory

National Provider Directory
Tax ID family
Genesis Eldercare Phys9 organizations share this tax ID, including this one

Other organizations with this tax ID 8

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

Locations

420 Dean Dr
Gardendale, AL 35071
Phone (205) 631-8700

150 Spring St
Morrison, CO 80465
Phone (303) 697-8181

2602 Highlands Blvd N
Palm Harbor, FL 34684
Phone (800) 276-4556

47 Margo Ave
Bardwell, KY 42023
Phone (270) 628-5424

1381 Campbell Ln
Bowling Green, KY 42104
Phone (270) 843-0587

4777 Alben Barkley Dr
Paducah, KY 42001
Phone (270) 534-1400

7520 Surratts Rd
Clinton, MD 20735
Phone (301) 856-1600

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1395014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564963200000",
    "number": "1033535828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 62946",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212642946",
            "telephone_number": "410-494-7607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16605 CHESTNUT GLEN PL",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40245",
            "telephone_number": "410-543-1957"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS ELDERCARE PHYSICIAN SERVICES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GENESIS HEALTHCARE, LLC",
        "enumeration_date": "2014-03-17",
        "last_updated": "2019-08-05",
        "status": "A",
        "authorized_official_last_name": "SHAPIRO",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "410-832-7790"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "KY",
            "license": "0858289.09",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.