Individual provider Active NPI

Genevieve Mae Febbraro, DO

  • Pediatrics Physician
  • Clarksville, TN
National Provider Identifier
1154821031
Registry record updated Aug 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
4379 Issued in TN
Practice address
490 Dunlop LN
Clarksville, TN 37040-5007
Phone
(931) 245-8400
NPI assigned
Feb 16, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 29, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 4379 TN Primary

Addresses

Primary practice location

490 Dunlop LN
Clarksville, TN 37040-5007

Mailing address

PO Box 3799
Clarksville, TN 37043-3799
Phone (931) 245-7000

Other identifiers 1

IdentifierTypeStateIssuer
Q066740MedicaidTN

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address genevieve.febbraro.1@7977.direct.athenahealth.com Direct Premier Medical Group PC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TN
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
I20210722001425 TN Practitioner - Pediatric Medicine 5991108375 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
4379TNMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Medical Group PC CurrentSince Sep 7, 2021 Accepting new patients

Interoperability endpoints

  • Direct secure messaging: genevieve.febbraro.1@7977.direct.athenahealth.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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1518739200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661731200000",
    "number": "1154821031",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3799",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370433799",
            "telephone_number": "931-245-7000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "490 DUNLOP LN",
            "city": "CLARKSVILLE",
            "state": "TN",
            "postal_code": "370405007",
            "telephone_number": "931-245-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FEBBRARO",
        "first_name": "GENEVIEVE",
        "middle_name": "MAE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-02-16",
        "last_updated": "2022-08-29",
        "certification_date": "2022-08-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "4379",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Q066740",
            "state": "TN"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "genevieve.febbraro.1@7977.direct.athenahealth.com",
            "affiliation": "Y",
            "affiliationName": "Premier Medical Group PC",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "490 Dunlop Ln",
            "city": "Clarksville",
            "state": "TN",
            "country_code": "US",
            "postal_code": "370405007",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Clarksville, TN

Sources for this page

Verify at the official NPI Registry.