NPIMap

Organization Active NPI

Genesis Medical PLLC

  • Pain Medicine (Anesthesiology) Physician
  • Ardmore, OK
National Provider Identifier
1285434233
Registry record updated Mar 24, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
Legal business name
GENESIS MEDICAL PLLC
Practice address
2002 12TH Ave NW Ste B
Ardmore, OK 73401-1206
Phone
(580) 221-2022
NPI assigned
Mar 18, 2025
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2025

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

Authorized official

Name
Sherry Lynne Clark
Title
Billing/Credentialing
Phone
(580) 223-5180

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207LP2900X Primary

Addresses

Primary practice location

2002 12TH Ave NW Ste B
Ardmore, OK 73401-1206

Mailing address

2002 12TH Ave NW Ste B
Ardmore, OK 73401-1206

Other names 2

  • Genesis Medical PLLC Doing business as
  • Southern Oklahoma Bone & Joint P C Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OK

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20250415002093 OK DME Supplier - Physician - General Practice 9739508698 Practice locations: Ardmore, OK

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

National Provider Directory

National Provider Directory
Tax ID family
Genesis Medical PLLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

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

{
    "created_epoch": "1742256000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742774400000",
    "number": "1285434233",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2002 12TH AVE NW STE B",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2002 12TH AVE NW STE B",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011206",
            "telephone_number": "580-221-2022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS MEDICAL PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-18",
        "last_updated": "2025-03-24",
        "certification_date": "2025-03-24",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_middle_name": "LYNNE",
        "authorized_official_title_or_position": "BILLING/CREDENTIALING",
        "authorized_official_telephone_number": "580-223-5180"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Genesis Medical PLLC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Southern Oklahoma Bone & Joint P C",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Ardmore, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 24, 2025; 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.