Genesiscare USA of Florida LLC

Primary specialty

Urology PhysicianTaxonomy code 208800000X

Legal business name

GENESISCARE USA OF FLORIDA LLC

Practice address

909 Mar Walt Dr
Suite 1011
Fort Walton Beach, FL 32547-6635

Phone

(850) 683-3377

NPI assigned

Dec 16, 2008

Organization subpart

Yes

Parent organization

GENESISCARE USA INCAs reported in NPPES

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

Authorized official

Name

Dan Collins

Title

President

Phone

(239) 931-7275

Specialties & licenses 1

Addresses

Other names 1

• Emerald Coast Urology Doing business as

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Joseph Mignone, MD

  • Hematology & Oncology Physician
  • Jacksonville, FL
  • NPI 1154318012
  NPD

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

{
    "created_epoch": "1229385600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598227200000",
    "number": "1174768477",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2160 COLONIAL BLVD",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339071410",
            "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": "909 MAR WALT DR",
            "address_2": "SUITE 1011",
            "city": "FORT WALTON BEACH",
            "state": "FL",
            "postal_code": "325476635",
            "telephone_number": "850-683-3377"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESISCARE USA OF FLORIDA LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GENESISCARE USA INC",
        "enumeration_date": "2008-12-16",
        "last_updated": "2020-08-24",
        "certification_date": "2020-08-24",
        "status": "A",
        "authorized_official_last_name": "COLLINS",
        "authorized_official_first_name": "DAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "239-931-7275"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Urology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Emerald Coast Urology",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Emerald Coast Urology",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hannah Gaylord, OTR/L
• Natasha Gebhardt
• Amber Mae Gee
• Genesis Health and Wellness, LLC
• Genesis OBGYN PA
• Genesiscare USA of Florida LLC
• Genoa Healthcare LLC
• Amber Lynn Gentry, LMHC
• George D. Edlund O.D., P.a.
• Erica A. George-Saintilus, MD

• Urology Physician in Fort Walton Beach, FL
• Providers in Fort Walton Beach, FL by specialty
• Urology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2020; 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.