Genesis Medical Diagnostics PLLC

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

Legal business name

GENESIS MEDICAL DIAGNOSTICS PLLC

Practice address

4195 Naco Perrin Blvd
San Antonio, TX 78217-2505

Phone

(210) 276-0045

Fax

(832) 565-1921

NPI assigned

Jul 23, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Ewan D. Johnson, MD, PHD

Title

Ceo/Founder

Phone

(281) 415-6687

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1626998400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631750400000",
    "number": "1245803402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14090 FM 2920 RD STE 345G",
            "city": "TOMBALL",
            "state": "TX",
            "postal_code": "773775549",
            "telephone_number": "281-415-6687"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4195 NACO PERRIN BLVD",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782172505",
            "telephone_number": "210-276-0045",
            "fax_number": "832-565-1921"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS MEDICAL DIAGNOSTICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-23",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A",
        "authorized_official_last_name": "JOHNSON",
        "authorized_official_first_name": "EWAN",
        "authorized_official_middle_name": "D.",
        "authorized_official_title_or_position": "CEO/FOUNDER",
        "authorized_official_telephone_number": "281-415-6687",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD, PHD"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CLIA NUMBER",
            "identifier": "45D2216609",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Generations Visiting Practitioners LLC
• Generosity Home Healthcare LLC
• Generous Home Care Management, LLC
• Genesis MD, PA
• Genesis Medical Case Management, LLC
• Genesis Rehabilitation Services, LLC
• Geneus Diagnostics
• Geneus Health
• Steven Gengenbacher, LPC
• Jordan Michael Gennero

• Clinical Medical Laboratory in San Antonio, TX
• Providers in San Antonio, TX by specialty
• Clinical Medical Laboratory in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2021; 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.