NPIMap

Organization Active NPI

Genesys Regional Medical Center

  • Pediatric Cardiology Physician
  • Grand Blanc, MI
National Provider Identifier
1306963053
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Cardiology PhysicianTaxonomy code 2080P0202X
Legal business name
GENESYS REGIONAL MEDICAL CENTER
Practice address
4642 Genesys Pkwy
Grand Blanc, MI 48439-8067
Phone
(810) 606-5830
Fax
(810) 606-5639
NPI assigned
Mar 26, 2007
Last updated
Jul 21, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Authorized official

Name
Richard Labaere DO
Title
Medical Education Director
Phone
(810) 715-4300

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208000000X
Pediatric Cardiology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2080P0202X MI Primary

Addresses

Primary practice location

4642 Genesys Pkwy
Grand Blanc, MI 48439-8067

Mailing address

PO Box 2015
Flint, MI 48501-2015
Phone (810) 606-5830

Other identifiers 1

IdentifierTypeStateIssuer
3G00009OtherMIHEALTHPLUS ID NUMBER

National Provider Directory

National Provider Directory
Tax ID family
Benjamin Burroughs PA37 organizations share this tax ID, including this one

Other organizations with this tax ID 36

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

View all 36

NPI Registry JSON

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

{
    "created_epoch": "1174867200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1306963053",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2015",
            "city": "FLINT",
            "state": "MI",
            "postal_code": "485012015",
            "telephone_number": "810-606-5830",
            "fax_number": "810-606-5639"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4642 GENESYS PKWY",
            "city": "GRAND BLANC",
            "state": "MI",
            "postal_code": "484398067",
            "telephone_number": "810-606-5830",
            "fax_number": "810-606-5639"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESYS REGIONAL MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-26",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "LABAERE DO",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "MEDICAL EDUCATION DIRECTOR",
        "authorized_official_telephone_number": "810-715-4300"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "2080P0202X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics, Pediatric Cardiology",
            "state": "MI",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTHPLUS ID NUMBER",
            "identifier": "3G00009",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Grand Blanc, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.