NPIMap

Organization Active NPI

Genesis Medical Group LLC

  • Geriatric Medicine (Family Medicine) Physician
  • Crooksville, OH
National Provider Identifier
1437218526
Registry record updated Dec 17, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
Legal business name
GENESIS MEDICAL GROUP LLC
Practice address
712 China Street
Crooksville Family Clinic Inc.
Crooksville, OH 43731-1124
Phone
(740) 982-6872
Fax
(740) 982-5551
NPI assigned
Dec 6, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2013

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

Authorized official

Name
Mr. Paul D Masterson
Title
Assist, Treasurer
Phone
(740) 454-4637

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Family Medicine) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207QG0300X Primary
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 207RG0300X
Rural Health Clinic/Center 261QR1300X

Addresses

Primary practice location

712 China Street
Crooksville Family Clinic Inc.
Crooksville, OH 43731-1124

Mailing address

945 Bethesda Drive
Suite 200
Zanesville, OH 43701-1880
Phone (740) 454-4788

Other identifiers 1

IdentifierTypeStateIssuer
2270313MedicaidOH

Other names 1

  • Crooksville Family Clinic Doing business as

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387238400000",
    "number": "1437218526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "945 BETHESDA DRIVE",
            "address_2": "SUITE 200",
            "city": "ZANESVILLE",
            "state": "OH",
            "postal_code": "437011880",
            "telephone_number": "740-454-4788",
            "fax_number": "740-450-6157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "712 CHINA STREET",
            "address_2": "CROOKSVILLE FAMILY CLINIC INC.",
            "city": "CROOKSVILLE",
            "state": "OH",
            "postal_code": "437311124",
            "telephone_number": "740-982-6872",
            "fax_number": "740-982-5551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS MEDICAL GROUP LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2013-12-17",
        "status": "A",
        "authorized_official_last_name": "MASTERSON",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "ASSIST, TREASURER",
        "authorized_official_telephone_number": "740-454-4637",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "207QG0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2270313",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Crooksville Family Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Crooksville, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2013; 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.