Edom Endale Genemo, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

0101283017 Issued in VA

Practice address

8316 Arlington Blvd Ste 300
Fairfax, VA 22031-5216

Phone

(703) 468-4195

Fax

(703) 280-9350

NPI assigned

Mar 26, 2021

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Virginia Pediatric Group

  • Physician Assistant
  • Fairfax, VA
  • NPI 1386785004
  NPD (past)
• Virginia Pediatric Group, LTD

  • Pediatrics Physician
  • Fairfax, VA
  • NPI 1396874905
  NPD (past)

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

{
    "created_epoch": "1616716800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1721001600000",
    "number": "1255918124",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8316 ARLINGTON BLVD STE 300",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220315216",
            "telephone_number": "703-573-2432"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8316 ARLINGTON BLVD STE 300",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220315216",
            "telephone_number": "703-468-4195",
            "fax_number": "703-280-9350"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2401 W Belvedere Ave",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212155216",
            "country_code": "US",
            "telephone_number": "410-601-7639",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GENEMO",
        "first_name": "EDOM",
        "middle_name": "ENDALE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2021-03-26",
        "last_updated": "2024-07-15",
        "certification_date": "2024-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VA",
            "license": "0101283017",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Susan Geiger, PT, DPT
• Nino Gelenidze, MD
• Beth Gelfand
• Daniel M Geller, MD
• Enkhjargal Gendenjamts
• General Internal Medicine Group
• General Medical Clinic, Inc.
• Genesis Psychiatric Solutions
• Genesis TMS & Wellness LLC
• Genetix Iq Inc

• Pediatrics Physician in Fairfax, VA
• Providers in Fairfax, VA by specialty
• Pediatrics Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.