NPIMap

Organization Active NPI

Genesis Eldercare Physician Services LLC

  • Geriatric Medicine (Internal Medicine) Physician
  • Albuquerque, NM
National Provider Identifier
1548615313
Registry record updated Aug 5, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X
Legal business name
GENESIS ELDERCARE PHYSICIAN SERVICES LLC
Practice address
7900 Constitution Ave NE
Albuquerque, NM 87110
Phone
(410) 769-7859
NPI assigned
Apr 29, 2016
Last updated
Aug 5, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2019

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

Authorized official

Name
Eric Shapiro
Title
Vice President
Phone
(410) 832-7790

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Geriatric Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RG0300X Primary

Addresses

Primary practice location

7900 Constitution Ave NE
Albuquerque, NM 87110

Mailing address

PO Box 62946
Baltimore, MD 21264-2946
Phone (410) 494-7607

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20170619000933 NM Part B Supplier - Clinic/Group Practice 9830002534 Receives reassigned benefits from 23 practitioners
Practice locations: Gallup, NM; Las Cruces, NM; Albuquerque, NM; Rio Rancho, NM; Roswell, NM; Santa Fe, NM; Silver City, NM; Farmington, NM…

Other NPIs with the same Medicare PAC ID 14

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

View all 14

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 25

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 25

NPI Registry JSON

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

{
    "created_epoch": "1461888000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1564963200000",
    "number": "1548615313",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 62946",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212642946",
            "telephone_number": "410-494-7607",
            "fax_number": "610-925-7387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7900 CONSTITUTION AVE NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87110",
            "telephone_number": "410-769-7859"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS ELDERCARE PHYSICIAN SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2016-04-29",
        "last_updated": "2019-08-05",
        "status": "A",
        "authorized_official_last_name": "SHAPIRO",
        "authorized_official_first_name": "ERIC",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "410-832-7790"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2019; 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.