NPIMap

Organization Active NPI

Genesis Wound Care Center LLC

  • Clinic/Center
  • Miami, FL
National Provider Identifier
1306516919
Registry record updated Sep 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
GENESIS WOUND CARE CENTER LLC
Practice address
4995 NW 72ND Ave Ste 406
Miami, FL 33166-5643
Phone
(305) 603-8410
Fax
(786) 431-5976
NPI assigned
Sep 15, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 16, 2021

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

Authorized official

Name
Mayelin AlonsoNPI 1710447172
Title
Owner
Phone
(305) 603-8410

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

4995 NW 72ND Ave Ste 406
Miami, FL 33166-5643

Mailing address

4995 NW 72ND Ave Ste 406
Miami, FL 33166-5643
Phone (305) 603-8410

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20211229002174 FL Part B Supplier - Clinic/Group Practice 7517358575 Receives reassigned benefits from 17 practitioners
Practice locations: Miami, FL

National Provider Directory

National Provider Directory

Locations

4995 NW 72nd Ave
Ste 406
Miami, FL 33166
Phone (305) 603-8410

Practitioners & affiliated clinicians

Practitioners 17

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

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1631664000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1631750400000",
    "number": "1306516919",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4995 NW 72ND AVE STE 406",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331665643",
            "telephone_number": "305-603-8410",
            "fax_number": "786-431-5976"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4995 NW 72ND AVE STE 406",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331665643",
            "telephone_number": "305-603-8410",
            "fax_number": "786-431-5976"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS WOUND CARE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-15",
        "last_updated": "2021-09-16",
        "certification_date": "2021-09-16",
        "status": "A",
        "authorized_official_last_name": "ALONSO",
        "authorized_official_first_name": "MAYELIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "305-603-8410"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Miami, FL

Sources for this page

  • 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.
  • 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.