NPIMap

Organization Active NPI

Genesis Pediatrics, LLC

Doing business as Genesis Pediatrics

  • Pediatrics Physician
  • Rochester, NY
National Provider Identifier
1306943527
Registry record updated Feb 5, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
GENESIS PEDIATRICS, LLC
Doing business as
Genesis Pediatrics
Practice address
900 Elmgrove Road
Rochester, NY 14624-6236
Phone
(585) 426-4100
Fax
(585) 426-3701
NPI assigned
Sep 20, 2006
Last updated
Feb 5, 2015By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 5, 2015

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

Authorized official

Name
Catherine A Goodfellow, M.D.NPI 1932281185
Title
Member/Owner
Phone
(585) 426-4100

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
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

900 Elmgrove Road
Rochester, NY 14624-6236

Mailing address

900 Elmgrove Road
Rochester, NY 14624-6236
Phone (585) 426-4100

Other identifiers 3

IdentifierTypeStateIssuer
01414680MedicaidNY
161328076OtherTRICARE REGION 1
00188076590OtherAETNA US HEALTHCARE

Other names 1

  • Genesis Pediatrics Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
33D0718906Genesis Pediatrics900 Elmgrove Road, Rochester, NY 14624Certificate of waiverApr 22, 2027

National Provider Directory

National Provider Directory

Locations

900 Elmgrove Rd
Rochester, NY 14624
Phone (585) 426-4100

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423094400000",
    "number": "1306943527",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "900 ELMGROVE ROAD",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146246236",
            "telephone_number": "585-426-4100",
            "fax_number": "585-426-3701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "900 ELMGROVE ROAD",
            "city": "ROCHESTER",
            "state": "NY",
            "postal_code": "146246236",
            "telephone_number": "585-426-4100",
            "fax_number": "585-426-3701"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS PEDIATRICS, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-20",
        "last_updated": "2015-02-05",
        "status": "A",
        "authorized_official_last_name": "GOODFELLOW",
        "authorized_official_first_name": "CATHERINE",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MEMBER/OWNER",
        "authorized_official_telephone_number": "585-426-4100",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01414680",
            "state": "NY"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE REGION 1",
            "identifier": "161328076",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA US HEALTHCARE",
            "identifier": "00188076590",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Genesis Pediatrics",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Rochester, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.