Individual provider Active NPI

Michael Genereux, D.O.

  • Family Medicine Physician
  • Clark, NJ
National Provider Identifier
1245590231
Registry record updated Jun 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25MB11790400 Issued in NJ
Practice address
67 Walnut Ave
Clark, NJ 07066-1640
Phone
(732) 388-7300
Fax
(732) 388-1330
NPI assigned
May 23, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 12, 2023

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 25MB11790400 NJ Primary
Family Medicine Physician 207Q00000X 279433 NY
Student in an Organized Health Care Education/Training Program 390200000X

Addresses

Primary practice location

67 Walnut Ave
Clark, NJ 07066-1640

Mailing address

1 Diamond Hill Rd
Berkeley Heights, NJ 07922-2104
Phone (908) 273-4300

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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
I20230629000720 NJ Practitioner - Family Practice 4486967098 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
New York College of Osteo Medicine of New York Institute of Technology, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Summit Medical Group PAGroup PAC ID 5395642276, 1,204 clinicians

Practice addresses (Care Compare)

1 Diamond Hill Rd
Berkeley Heights, NJ 07922-2104
Phone (908) 273-4300

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Medical Group PA CurrentSince Jun 5, 2023 Accepting new patients
Summit Medical Group PA CurrentSince Jun 5, 2023 Accepting new patients
Summit Medical Group, Inc Family Medicine Past Accepting new patients

Locations

1 Diamond Hill Rd
Berkeley Heights, NJ 07922
Phone (908) 277-8868

67 Walnut Ave
Clark, NJ 07066
Phone (732) 388-7300

150 Floral Ave
New Providence, NJ 07974
Phone (908) 588-3890

Interoperability endpoints

  • Direct secure messaging: michael.t.genereux.1@2983.direct.athenahealth.com

Organizations & group practices 3

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.

Hospital & facility affiliations 3

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": "1337731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686528000000",
    "number": "1245590231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 DIAMOND HILL RD",
            "city": "BERKELEY HEIGHTS",
            "state": "NJ",
            "postal_code": "079222104",
            "telephone_number": "908-273-4300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "67 WALNUT AVE",
            "city": "CLARK",
            "state": "NJ",
            "postal_code": "070661640",
            "telephone_number": "732-388-7300",
            "fax_number": "732-388-1330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENEREUX",
        "first_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-05-23",
        "last_updated": "2023-06-12",
        "certification_date": "2023-06-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MB11790400",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "279433",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clark, NJ

Sources for this page

Verify at the official NPI Registry.