Active NPI
Dr. Genova, LLC
- Internal Medicine Physician
- O'Fallon, MO
National Provider Identifier
1396889960
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- Legal business name
- DR. GENOVA, LLC
- Practice address
- 5551 Winghaven Blvd Ste 250
O Fallon, MO 63368-3630 - Phone
- (636) 695-2520
- Fax
- (314) 590-5925
- NPI assigned
- Feb 16, 2007
- Last updated
- Apr 6, 2021
- Organization subpart
- Yes
- Parent organization
- ST. LUKE'S MEDICAL GROUP
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- James Snider
- Title
- VP Physician Network
- Phone
- (636) 685-7804
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | Primary |
Addresses
Primary practice location
5551 Winghaven Blvd Ste 250
O Fallon, MO 63368-3630
Mailing address
232 S Woods Mill Rd
Chesterfield, MO 63017-3406
Phone (366) 685-7804
Other practice location 1
224 S Woods Mill Rd Ste 450
Chesterfield, MO 63017-3513
Phone (636) 695-2520
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| DD8375 | Other | MO | RR MEDICARE |
National Provider Directory
National Provider Directory- Part of
- St Lukes Medical Group
Member of 1
Organizations this organization is a member of, according to the National Provider Directory.
Locations
232 S Woods Mill Rd
Town and Country, MO 63017
Phone (314) 205-6030
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1171584000000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1617667200000",
"number": "1396889960",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "232 S WOODS MILL RD",
"city": "CHESTERFIELD",
"state": "MO",
"postal_code": "630173406",
"telephone_number": "366-685-7804",
"fax_number": "314-576-2433"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5551 WINGHAVEN BLVD STE 250",
"city": "O FALLON",
"state": "MO",
"postal_code": "633683630",
"telephone_number": "636-695-2520",
"fax_number": "314-590-5925"
}
],
"practiceLocations": [
{
"address_1": "224 S Woods Mill Rd Ste 450",
"address_purpose": "LOCATION",
"city": "Chesterfield",
"state": "MO",
"postal_code": "630173513",
"country_code": "US",
"telephone_number": "636-695-2520",
"fax_number": "314-590-5925",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "DR. GENOVA, LLC",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "ST. LUKE'S MEDICAL GROUP",
"enumeration_date": "2007-02-16",
"last_updated": "2021-04-06",
"certification_date": "2021-04-06",
"status": "A",
"authorized_official_last_name": "SNIDER",
"authorized_official_first_name": "JAMES",
"authorized_official_title_or_position": "VP PHYSICIAN NETWORK",
"authorized_official_telephone_number": "636-685-7804"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "DD8375",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in O'Fallon, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.