NPIMap

Organization Active NPI

Genesiscare USA of Florida LLC

Doing business as GenesisCare Urology

  • Urology Physician
  • Fort Myers, FL
National Provider Identifier
1043986284
Registry record updated Sep 25, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
Legal business name
GENESISCARE USA OF FLORIDA LLC
Doing business as
GenesisCare Urology
Practice address
4571 Colonial Blvd Ste 110
Fort Myers, FL 33966-1156
Phone
(239) 931-7342
Fax
(239) 931-7385
NPI assigned
Aug 18, 2021
Last updated
Sep 25, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 25, 2023

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

Authorized official

Name
Shaden Marzouk
Title
President
Phone
(239) 931-7254

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 208800000X Primary

Addresses

Primary practice location

4571 Colonial Blvd Ste 110
Fort Myers, FL 33966-1156

Mailing address

1419 SE 8TH Ter Ste 200
Cape Coral, FL 33990-3213
Phone (239) 931-7342

Other names 1

  • GenesisCare Urology Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

National Provider Directory
Tax ID family
Radiation Therapy Assoc72 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 14

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

View all 14

Interoperability endpoints

  • Direct secure messaging: brynnmona@genesiscareuro.medalliesdirect.net
  • Direct secure messaging: christopherdiblasio@genesiscareuro.medalliesdirect.net
  • Direct secure messaging: erinheitman@genesiscareuro.medalliesdirect.net

Practitioners & affiliated clinicians

Practitioners 3

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": "1629244800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1695600000000",
    "number": "1043986284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1419 SE 8TH TER STE 200",
            "city": "CAPE CORAL",
            "state": "FL",
            "postal_code": "339903213",
            "telephone_number": "239-931-7342",
            "fax_number": "239-931-7385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4571 COLONIAL BLVD STE 110",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339661156",
            "telephone_number": "239-931-7342",
            "fax_number": "239-931-7385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESISCARE USA OF FLORIDA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-08-18",
        "last_updated": "2023-09-25",
        "certification_date": "2023-09-25",
        "status": "A",
        "authorized_official_last_name": "MARZOUK",
        "authorized_official_first_name": "SHADEN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "239-931-7254"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GenesisCare Urology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "GenesisCare Urology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Myers, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 25, 2023; 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.