Genesis Medical Practice, PLLC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

GENESIS MEDICAL PRACTICE, PLLC

Practice address

1921 New Garden Rd
Greensboro, NC 27410-2193

Phone

(919) 370-8188

NPI assigned

Sep 10, 2024

Organization subpart

No

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

Authorized official

Name

Dr. Brian Shackleford, MDNPI 1154777662

Title

Owner

Phone

(919) 370-8188

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

Enrollment records 1

Practitioners 1

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

• Brian Shackleford, MD

  • Internal Medicine Physician
  • Winston Salem, NC
  • NPI 1154777662
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1725926400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1725926400000",
    "number": "1205662004",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1921 NEW GARDEN RD APT I104",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274102200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1921 NEW GARDEN RD",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274102193",
            "telephone_number": "919-370-8188"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS MEDICAL PRACTICE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-09-10",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A",
        "authorized_official_last_name": "SHACKLEFORD",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "919-370-8188",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTHCARE",
            "identifier": "7154047",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Coleen Gelmann, CRNA
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• Generations Family Practice, PA
• Genesis Community Support Services, LLC
• Genesis Mind Care
• Geneva'S Touch Home Care Agency, LLC
• Genoa Healthcare LLC
• Gental Hands of North Carolina LLC
• Jennifer Kennedy Gentel, RN

• Internal Medicine Physician in Greensboro, NC
• Providers in Greensboro, NC by specialty
• Internal Medicine Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2024; 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.