Genesiscare USA of Florida LLC
Organization Active NPI Urology Physician · Port Charlotte, FL
NPI 1043465099 · NPPES record last updated Oct 5, 2023
Key facts
- NPI
- 1043465099
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Urology Physician 208800000X
- Legal business name
- GENESISCARE USA OF FLORIDA LLC
- Practice address
- 3410 Tamiami TRL
Suite 4
Port Charlotte, FL 33952-8112 - Phone
- (941) 235-7281
- Fax
- (941) 235-0463
- NPI assigned
- Nov 18, 2008
- Organization subpart
- Yes
- Parent organization (as reported)
- GENESIS CARE USA INC
Authorized official
- Name
- Shaden Marzouk
- Title
- President
- Phone
- (239) 931-7254
Corporate family (same tax ID) 13
Practitioners 3
-
Grace Carpinello, NP
-
Edward Herrman, MD
-
Nisha Navin Patel, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040204000663 | FL | Part B Supplier - Clinic/Group Practice | 9830082882 |
Receives reassigned benefits from 314 practitioners This NPI is an additional NPI on the enrollment |
National Provider Directory
- Tax ID family
- Genesiscare USA of Florida LLC
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician |
208800000X | Yes |
Addresses
Primary practice location
3410 Tamiami TRL
Suite 4
Port Charlotte, FL 33952-8112
Mailing address
1419 SE 8TH Ter Ste 200
Cape Coral, FL 33990-3213
Phone (239) 931-7342
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| CE7138 | Other | FL | RAILROAD MEDICARE |
Other names
- Marc A Melser MD
Other providers in Port Charlotte, FL
- Patricia Gaudette
- Martha Gaudiel
- Lindsey Rae Geist
- Richard Gelder
- Genes Prescription Shop LTC
- Genesiscare USA of Florida LLC
- Genesiscare USA of Florida LLC
- George Harris
- George Nackley MD PL
- Elizabeth A George
All providers in Port Charlotte, FL · Urology Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 5, 2023. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.