Elizabeth Reardon Walsh, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

225721 Issued in NY

Practice address

900 Elmgrove Road
Rochester, NY 14624-6236

Phone

(585) 426-4100

Fax

(585) 426-3701

NPI assigned

Sep 14, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 7

Other names 1

• Elizabeth Stone Reardon Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Genesis Pediatrics, LLC

  • Pediatrics Physician
  • Rochester, NY
  • NPI 1306943527
  NPD (past)
• Rochester General Hospital

  • General Acute Care Hospital
  • Rochester, NY
  • NPI 1063531929
  NPD (past)

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574208000000",
    "number": "1154426880",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 ELMGROVE RD",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146246236",
            "telephone_number": "585-426-4100",
            "fax_number": "585-426-2026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 ELMGROVE ROAD",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146246236",
            "telephone_number": "585-426-4100",
            "fax_number": "585-426-3701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALSH",
        "first_name": "ELIZABETH",
        "middle_name": "REARDON",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-14",
        "last_updated": "2019-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NY",
            "license": "225721",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EXCELLUS BLUE CHOICEE",
            "identifier": "P010225721",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02380110",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MVP UPSTATE DHP",
            "identifier": "7701666",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF ROCHESTER",
            "identifier": "P010225721",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERRED CARE",
            "identifier": "MDH518",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA US HEALTHCARE",
            "identifier": "7429371",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "POMCO",
            "identifier": "RC60225721",
            "state": null
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "lizw@genesispediatrics.medentdirect.com",
            "affiliation": "N",
            "endpointDescription": "Medent",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "900 Elmgrove Road",
            "city": "Rochester",
            "state": "NY",
            "country_code": "US",
            "postal_code": "146246236",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "ELIZABETH",
            "last_name": "REARDON",
            "middle_name": "STONE",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Brynn Elizabeth Waloven, MSW
• Nicole Marie Walrath, DO
• Sara Walrath, LMT
• Connor Patrick Walsh, MS CCC-SLP
• Edward E Walsh, MD
• Emily Walsh, M.D.
• Emmett Patrick Walsh, MSW, LCSW/LICSW
• Jared P Walsh, M.D.
• Julia Kathleen Walsh, FNP-C
• Kelly S Walsh, SLP

• Pediatrics Physician in Rochester, NY
• Providers in Rochester, NY by specialty
• Pediatrics Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2019; 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.