NPIMap

Organization Active NPI

Genesis Vascular of Pooler, LLC

  • Interventional Cardiology Physician
  • Pooler, GA
National Provider Identifier
1376930339
Registry record updated Nov 13, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Cardiology PhysicianTaxonomy code 207RI0011X
Legal business name
GENESIS VASCULAR OF POOLER, LLC
Practice address
1000 Towne Center Blvd
Building 400
Pooler, GA 31322-4052
Phone
(912) 662-0223
Fax
(912) 662-0224
NPI assigned
Apr 16, 2015
Last updated
Nov 13, 2015By the provider in NPPES
Organization subpart
Yes
Parent organization
GENESIS GLOBAL HEALTHCAREAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Nov 13, 2015

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

Authorized official

Name
James Thomas O'Dare III
Title
Principal
Phone
(856) 335-5025

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X NU
Interventional Cardiology Physician 207RI0011X NU Primary
Vascular & Interventional Radiology Physician 2085R0204X NU
Vascular Surgery Physician 2086S0129X NU

Addresses

Primary practice location

1000 Towne Center Blvd
Building 400
Pooler, GA 31322-4052

Mailing address

575 N Route 73
Ste A6
West Berlin, NJ 08091-9289
Phone (856) 335-5025

Other names 1

  • GV of Pooler Other name

National Provider Directory

National Provider Directory

Locations

1000 Towne Center Blvd
Ste 400
Pooler, GA 31322
Phone (912) 662-0223

Practitioners & affiliated clinicians

Practitioners 14

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 14

NPI Registry JSON

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

{
    "created_epoch": "1429142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447372800000",
    "number": "1376930339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "575 N ROUTE 73",
            "address_2": "STE A6",
            "city": "WEST BERLIN",
            "state": "NJ",
            "postal_code": "080919289",
            "telephone_number": "856-335-5025",
            "fax_number": "856-213-9269"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1000 TOWNE CENTER BLVD",
            "address_2": "BUILDING 400",
            "city": "POOLER",
            "state": "GA",
            "postal_code": "313224052",
            "telephone_number": "912-662-0223",
            "fax_number": "912-662-0224"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS VASCULAR OF POOLER, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GENESIS GLOBAL HEALTHCARE",
        "enumeration_date": "2015-04-16",
        "last_updated": "2015-11-13",
        "status": "A",
        "authorized_official_last_name": "O'DARE",
        "authorized_official_first_name": "JAMES",
        "authorized_official_middle_name": "THOMAS",
        "authorized_official_title_or_position": "PRINCIPAL",
        "authorized_official_telephone_number": "856-335-5025",
        "authorized_official_name_suffix": "III"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207RI0011X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Interventional Cardiology",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "2085R0204X",
            "taxonomy_group": "",
            "desc": "Radiology, Vascular & Interventional Radiology",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "GV of Pooler",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Pooler, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2015; 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.