Individual provider Active NPI

Arvi Mallari Generoso, M.D.

  • Internal Medicine Physician
  • Castl Rock, WA
National Provider Identifier
1104104025
Registry record updated Sep 30, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
MD60441564 Issued in WA
Practice address
23 Cowlitz W St
Castl Rock, WA 98611
Phone
(360) 800-9480
Fax
(360) 800-9486
NPI assigned
Jul 26, 2011
Last updated
Sep 30, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 30, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X MD60441564 WA Primary

Addresses

Primary practice location

23 Cowlitz W St
Castl Rock, WA 98611

Mailing address

PO Box 1163
Castle Rock, WA 98611-1163
Phone (360) 800-9480

Other names 1

  • Arvi Pastoral Mallari Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20140812000037 WA Practitioner - Internal Medicine 6406089853 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Other, 2005
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

23 Cowlitz St W
Castle Rock, WA 98611-9267
Phone (360) 800-9480

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Generoso Health LLC CurrentSince Nov 2, 2021 Accepting new patients

Locations

202 Cowlitz St W
Castle Rock, WA 98611

202 Cowlitz St W
Ste 1163
Castle Rock, WA 98611

Interoperability endpoints

  • Direct secure messaging: generosohealth.arvigeneroso@161227.advancedmd-direct.com

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1311638400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1664496000000",
    "number": "1104104025",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1163",
            "city": "CASTLE ROCK",
            "state": "WA",
            "postal_code": "986111163",
            "telephone_number": "360-800-9480",
            "fax_number": "360-800-9486"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23 COWLITZ W ST",
            "city": "CASTL ROCK",
            "state": "WA",
            "postal_code": "98611",
            "telephone_number": "360-800-9480",
            "fax_number": "360-800-9486"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENEROSO",
        "first_name": "ARVI",
        "middle_name": "MALLARI",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-07-26",
        "last_updated": "2022-09-30",
        "certification_date": "2022-09-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD60441564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ARVI",
            "last_name": "MALLARI",
            "middle_name": "PASTORAL",
            "credential": "M.D.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Sources for this page

Verify at the official NPI Registry.