NPIMap

Organization Active NPI

Genesis Health and Wellness LLC

  • Customized Equipment (DME)
  • Newburgh, IN
National Provider Identifier
1336470616
Registry record updated Aug 30, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Customized Equipment (DME)Taxonomy code 332BC3200X
License
08002011A Issued in IN
Legal business name
GENESIS HEALTH AND WELLNESS LLC
Practice address
8211 W State Route 66
Newburgh, IN 47630-2534
Phone
(812) 858-1005
Fax
(812) 858-1001
NPI assigned
Jan 26, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2012

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

Authorized official

Name
Dr. Shaun P Tymchak, DCNPI 1346243870
Title
Director
Phone
(812) 858-1005

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 3

Specialty (taxonomy)CodeLicenseStatePrimary
Nutrition Education NutritionistGroup: 193200000X MULTI-SPECIALTY GROUP 133NN1002X 08002011A IN
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
Customized Equipment (DME) 332BC3200X 08002011A IN Primary

Addresses

Primary practice location

8211 W State Route 66
Newburgh, IN 47630-2534

Mailing address

8211 W State Route 66
Newburgh, IN 47630-2534
Phone (812) 858-1005

Other identifiers 1

IdentifierTypeStateIssuer
201085220AMedicaidIN

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

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": "1264464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346284800000",
    "number": "1336470616",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8211 W STATE ROUTE 66",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476302534",
            "telephone_number": "812-858-1005",
            "fax_number": "812-858-1001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8211 W STATE ROUTE 66",
            "city": "NEWBURGH",
            "state": "IN",
            "postal_code": "476302534",
            "telephone_number": "812-858-1005",
            "fax_number": "812-858-1001"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS HEALTH AND WELLNESS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-01-26",
        "last_updated": "2012-08-30",
        "status": "A",
        "authorized_official_last_name": "TYMCHAK",
        "authorized_official_first_name": "SHAUN",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "812-858-1005",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "133NN1002X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nutritionist, Nutrition, Education",
            "state": "IN",
            "license": "08002011A",
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "332BC3200X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Customized Equipment",
            "state": "IN",
            "license": "08002011A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201085220A",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Newburgh, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2012; 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.