Organization Active NPI

Genomind, Inc.

Clinical Medical Laboratory
King of Prussia, PA

National Provider Identifier

1467850859

Registry record updated Dec 6, 2019

On this page

Key facts
NPPES NPI Registry
Medicare participation
Laboratory certificates & supplier records
National Provider Directory
Practitioners & affiliated clinicians
NPI Registry JSON
Other providers in King of Prussia, PA
Sources for this page

Key facts

NPPES NPI Registry

Primary specialty: Clinical Medical LaboratoryTaxonomy code 291U00000X
License: 23066 Issued in PA
Legal business name: GENOMIND, INC.
Practice address: 2200 Renaissance Blvd
Suite 100
King of Prussia, PA 19406-2755
Phone: (877) 895-8658
Fax: (844) 364-5850
NPI assigned: Dec 17, 2014
Organization subpart: No

NPPES NPI Registry

Updated by the provider on Dec 6, 2019

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

Authorized official

Name: Mr. Shawn Patrick O'Brien
Title: Ceo
Phone: (877) 895-8658

Specialties & licenses 1

Specialty (taxonomy)	Code	License	State	Primary
Clinical Medical Laboratory	291U00000X	23066	PA	Primary

Addresses

Primary practice location

2200 Renaissance Blvd
Suite 100
King of Prussia, PA 19406-2755

Mailing address

2200 Renaissance Blvd Ste 100
King of Prussia, PA 19406-2755
Phone (877) 895-8658

Other identifiers 50

Identifier	Type	State	Issuer
1467850859	Medicaid	CA
1467850859	Medicaid	ME
161953	Medicaid	AZ
2269	Other	MD	STATE OF MD LABORATORY LICENSE
360077701	Medicaid	TX
CDS00800594	Other	CA	STATE OF CA LABORATORY LICENSE
KMAP201122390B	Medicaid	KS
13828056	Medicaid	DC
1467850859	Medicaid	MI
2049308	Medicaid	WA
700023645	Medicaid	MO
10026540600	Medicaid	NE
137273	Medicaid	OH
1467850859	Medicaid	VA
1467850859	Medicaid	MN
1467850859	Medicaid	ID
158836	Medicaid	MS
215185709	Medicaid	AR
103020171-0001	Medicaid	PA
17044500	Medicaid	FL
186566	Medicaid	AL
3108879	Medicaid	NH
3717011-00	Medicaid	MD
9035	Other	NY	STATE OF NY LABORATORY LICENSE PFI:
9046391	Other		CAP CERTIFICATION
93875061	Medicaid	CO
100049283	Medicaid	WI
1026839	Medicaid	VT
10670297	Medicaid	NM
39D2088097	Other	PA	CLIA
500697689	Medicaid	OR
200146410	Medicaid	DE
2011186	Medicaid	SD
201293610A	Medicaid	IN
707801	Medicaid	IA
7100401540	Medicaid	KY
LCO00912	Other	RI	STATE OF RI LABORATORY LICENSE
003164790A	Medicaid	GA
141301500	Medicaid	WY
1467850859	Medicaid	UT
1633397	Medicaid	AK
200626210A	Medicaid	OK
426933	Medicaid	MT
Q021455	Medicaid	TN
146193717L00490	Medicaid	SC
1467110	Medicaid	ND
1467850859	Medicaid	NC
2411357	Medicaid	LA
499919	Medicaid	NJ
800027721	Other	FL	STATE OF FL LABORATORY LICENSE

Medicare participation

Medicare enrollment files

Medicare fee-for-service enrollment: Enrolled in PA

Enrollment records 1

Enrollment ID	State	Provider type	PAC ID	Details
O20150311001662	PA	Part B Supplier - Independent Clinical Laboratory	2062738990	Practice locations: King of Prussia, PA

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 number	Laboratory	Certificate	Expires
39D2088097	Genomind, Inc2200 Renaissance Blvd, Suite 100, King of Prussia, PA 19406	Accreditation	Jan 24, 2027

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

David Robbins, PHD
- Clinical Laboratory Director (Non-physician)
- King of Prussia, PA
- NPI 1750909743
NPD

NPI Registry JSON

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

{
    "created_epoch": "1418774400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1575590400000",
    "number": "1467850859",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2200 RENAISSANCE BLVD STE 100",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194062755",
            "telephone_number": "877-895-8658",
            "fax_number": "844-364-5850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2200 RENAISSANCE BLVD",
            "address_2": "SUITE 100",
            "city": "KING OF PRUSSIA",
            "state": "PA",
            "postal_code": "194062755",
            "telephone_number": "877-895-8658",
            "fax_number": "844-364-5850"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENOMIND, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-17",
        "last_updated": "2019-12-06",
        "status": "A",
        "authorized_official_last_name": "O'BRIEN",
        "authorized_official_first_name": "SHAWN",
        "authorized_official_middle_name": "PATRICK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "877-895-8658",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "PA",
            "license": "23066",
            "primary": true
        }
    ],
    "identifiers": [
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            "state": "CA"
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            "state": "ME"
        },
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        },
        {
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            "identifier": "2269",
            "state": "MD"
        },
        {
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            "identifier": "360077701",
            "state": "TX"
        },
        {
            "code": "01",
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            "issuer": "STATE OF CA LABORATORY LICENSE",
            "identifier": "CDS00800594",
            "state": "CA"
        },
        {
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            "state": "MI"
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            "state": "WA"
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            "identifier": "137273",
            "state": "OH"
        },
        {
            "code": "05",
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            "identifier": "1467850859",
            "state": "VA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1467850859",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1467850859",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
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            "identifier": "158836",
            "state": "MS"
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        {
            "code": "05",
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        },
        {
            "code": "05",
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            "issuer": null,
            "identifier": "103020171-0001",
            "state": "PA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "17044500",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "186566",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3108879",
            "state": "NH"
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        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3717011-00",
            "state": "MD"
        },
        {
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            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF NY LABORATORY LICENSE PFI:",
            "identifier": "9035",
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        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAP CERTIFICATION",
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        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "93875061",
            "state": "CO"
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            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
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            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
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        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10670297",
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        },
        {
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            "issuer": "CLIA",
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        },
        {
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        {
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            "desc": "MEDICAID",
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        },
        {
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            "desc": "Other (non-Medicare)",
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            "identifier": "LCO00912",
            "state": "RI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003164790A",
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        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "141301500",
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        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1467850859",
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        {
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        {
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        {
            "code": "05",
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        },
        {
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            "issuer": null,
            "identifier": "1467850859",
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            "identifier": "499919",
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        },
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            "identifier": "800027721",
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        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in King of Prussia, PA

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.