NPIMap

Organization Active NPI

Genesis Community Health, Inc.

  • Federally Qualified Health Center (FQHC)
  • Boynton Beach, FL
National Provider Identifier
1447578125
Registry record updated Nov 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GENESIS COMMUNITY HEALTH, INC.
Practice address
709 S Federal Hwy Ste 3
Boynton Beach, FL 33435-5610
Phone
(561) 735-6553
Fax
(561) 735-7739
NPI assigned
May 5, 2010
Last updated
Nov 4, 2024By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 4, 2024

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

Authorized official

Name
Deanna Moultrie Warren
Title
Ceo
Phone
(561) 735-6553

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X
Community Health Clinic/Center 261QC1500X
Federally Qualified Health Center (FQHC) 261QF0400X Primary

Addresses

Primary practice location

709 S Federal Hwy Ste 3
Boynton Beach, FL 33435-5610

Mailing address

639 E Ocean Ave Ste 409
Boynton Beach, FL 33435-5017
Phone (561) 806-6835

Other identifiers 4

IdentifierTypeStateIssuer
002267000MedicaidFL
EC290AOtherFLMEDICARE
006608600MedicaidFL
101108OtherFLMEDICARE

Other names 1

  • Boynton Beach Medical Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20110112000690 FL Part B Supplier - Clinic/Group Practice 7012033384 Receives reassigned benefits from 19 practitioners
1 other NPI on this enrollment
Practice locations: Boca Raton, FL; Boynton Beach, FL
O20130107000196 FL Part A Provider - Federally Qualified Health Center (FQHC) 7012033384 Practice locations: Boynton Beach, FL

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1447578125. Details of each certification follow.

Federally qualified health center certification: CCN 101108

Legal name
GENESIS COMMUNITY HEALTH, INC
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jan 14, 2013
Last certification
Jan 14, 2013
Ownership / control type
For profit – corporation
Organization structure
CorporationNon-profit
Enrollment address
709 S Federal Hwy
Ste 3
Boynton Beach, FL 33435-5610

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D2009690Genesis Community Health Inc709 South Federal Highway Suite 3, Boynton Beach, FL 33435Certificate of waiverJul 8, 2028

National Provider Directory

National Provider Directory
Tax ID family
Atlantis High7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

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

Locations

600 S Dixie Hwy
Ste 103
Boca Raton, FL 33432
Phone (561) 395-1011

2623 S Seacrest Blvd
Ste 65
Boynton Beach, FL 33435
Phone (561) 806-6835

Ownership & related parties

All disclosed owners & managing parties 7

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Ramona Hupp Individual Corporate DirectorBoard Member Jan 1, 2012
Lisa McMiller Individual Corporate DirectorBoard Member Jan 1, 2012
Chorinne Jack Individual Corporate DirectorBoard Member Jan 1, 2012
Manuel Rodriguez Individual Corporate DirectorBoard Member Jan 1, 2012
Judith Drumm Individual Corporate DirectorBoard Member Jan 1, 2012
Deanna M Warren Individual Corporate DirectorPresident/Ceo Mar 17, 2009 100%
W-2 Managing EmployeePresident/Ceo Mar 17, 2009 100%
Myra K Jones Individual Corporate DirectorBoard Member Jan 1, 2012

Practitioners & affiliated clinicians

Practitioners 19

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 19

NPI Registry JSON

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

{
    "created_epoch": "1273017600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1730678400000",
    "number": "1447578125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "639 E OCEAN AVE STE 409",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334355017",
            "telephone_number": "561-806-6835",
            "fax_number": "561-806-6607"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "709 S FEDERAL HWY STE 3",
            "city": "BOYNTON BEACH",
            "state": "FL",
            "postal_code": "334355610",
            "telephone_number": "561-735-6553",
            "fax_number": "561-735-7739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS COMMUNITY HEALTH, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-05-05",
        "last_updated": "2024-11-04",
        "certification_date": "2024-11-04",
        "status": "A",
        "authorized_official_last_name": "WARREN",
        "authorized_official_first_name": "DEANNA",
        "authorized_official_middle_name": "MOULTRIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "561-735-6553"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002267000",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "EC290A",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "006608600",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE",
            "identifier": "101108",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Boynton Beach Medical",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Boynton Beach, FL

Sources for this page

Verify at the official NPI Registry.