Genesis Medical Practice Management

Primary specialty

PsychologistTaxonomy code 103T00000X

Legal business name

GENESIS MEDICAL PRACTICE MANAGEMENT

Practice address

4620 N 16TH St
E-110
Phoenix, AZ 85016-5121

Phone

(602) 264-2770

Fax

(866) 534-1701

NPI assigned

Dec 14, 2012

Last updated

Dec 14, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Daryl C. Millar

Title

Ceo

Phone

(602) 264-2770

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1355443200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1355443200000",
    "number": "1053657361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4620 N 16TH ST",
            "address_2": "E-110",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850165121",
            "telephone_number": "602-264-2770",
            "fax_number": "866-534-1701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4620 N 16TH ST",
            "address_2": "E-110",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850165121",
            "telephone_number": "602-264-2770",
            "fax_number": "866-534-1701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS MEDICAL PRACTICE MANAGEMENT",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-12-14",
        "last_updated": "2012-12-14",
        "status": "A",
        "authorized_official_last_name": "MILLAR",
        "authorized_official_first_name": "DARYL",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "602-264-2770",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Generational Bridges Neuropsychological Services PLLC
• Genesis Behavioral Clinic LLC
• Genesis Community LLC
• Genesis Homecare Agency
• Genesis Hospicecare Services, Inc.
• Genesis Mobile Doctors
• Bryan Albert Gengenbach, PHARMD
• Jessica Anne Gennaro, LCSW
• Randi Janelle Gennaro, MSC, LAC
• Adam Kimball Geno, MSN, PMHNP-BC

• Psychologist in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Psychologist in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.