NPIMap

Organization Active NPI

Genesis Family Practice LLC

  • General Practice Physician
  • Ormond Beach, FL
National Provider Identifier
1447799242
Registry record updated Nov 28, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice PhysicianTaxonomy code 208D00000X
License
OS8600 Issued in FL
Legal business name
GENESIS FAMILY PRACTICE LLC
Practice address
800 S Nova Rd
Suite I
Ormond Beach, FL 32174-9048
Phone
(386) 676-9300
Fax
(386) 676-9050
NPI assigned
Feb 14, 2017
Reactivated
Apr 17, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2022

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

Authorized official

Name
Jay C Chanmugam, D.ONPI 1518905207
Title
Owner
Phone
(386) 218-2353

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208D00000X OS8600 FL Primary

Addresses

Primary practice location

800 S Nova Rd
Suite I
Ormond Beach, FL 32174-9048

Mailing address

1133 Saxon Blvd
Ste 200
Orange City, FL 32763-8425
Phone (386) 218-2353

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20130226000215 FL Part B Supplier - Clinic/Group Practice 8921253816 Receives reassigned benefits from 6 practitioners
1 other NPI on this enrollment
This NPI is an additional NPI on the enrollment
Practice locations: Ormond Beach, FL; Orange City, FL

Other NPIs on the same Medicare enrollment 1

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

National Provider Directory

National Provider Directory
Tax ID family
Genesis Family Practice LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

800 S Nova Rd
Ste 1
Ormond Beach, FL 32174
Phone (386) 676-9300

Practitioners & affiliated clinicians

Practitioners 6

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": "1487030400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669593600000",
    "number": "1447799242",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1133 SAXON BLVD",
            "address_2": "STE 200",
            "city": "ORANGE CITY",
            "state": "FL",
            "postal_code": "327638425",
            "telephone_number": "386-218-2353",
            "fax_number": "386-228-9701"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 S NOVA RD",
            "address_2": "SUITE I",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321749048",
            "telephone_number": "386-676-9300",
            "fax_number": "386-676-9050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS FAMILY PRACTICE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-02-14",
        "last_updated": "2022-11-28",
        "certification_date": "2022-11-28",
        "deactivation_date": "2018-04-09",
        "reactivation_date": "2018-04-17",
        "status": "A",
        "authorized_official_last_name": "CHANMUGAM",
        "authorized_official_first_name": "JAY",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "386-218-2353",
        "authorized_official_credential": "D.O"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": "FL",
            "license": "OS8600",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ormond Beach, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.