NPIMap

Organization Active NPI

Genesis Medical PLLC

  • Interventional Pain Medicine Physician
  • Durant, OK
National Provider Identifier
1568369700
Registry record updated Oct 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
GENESIS MEDICAL PLLC
Practice address
698 Westside Dr Ste 102
Durant, OK 74701-3085
Phone
(580) 221-2022
NPI assigned
Oct 21, 2026
Last updated
Oct 21, 2026By the provider in NPPES
Organization subpart
Yes
Parent organization
GENESIS MEDICAL PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Oct 21, 2026

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

Authorized official

Name
Sherry Lynne Clark
Title
Credentialing, Billing
Phone
(580) 223-5180

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X
Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0000X
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X Primary

Addresses

Primary practice location

698 Westside Dr Ste 102
Durant, OK 74701-3085

Mailing address

2002 12TH Ave NW Ste B
Ardmore, OK 73401-1206

Other names 1

  • Southern Oklahoma Pain Management Other name

National Provider Directory

National Provider Directory
Tax ID family
Genesis Medical PLLC6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the 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, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1792540800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792540800000",
    "number": "1568369700",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2002 12TH AVE NW STE B",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "698 WESTSIDE DR STE 102",
            "city": "DURANT",
            "state": "OK",
            "postal_code": "747013085",
            "telephone_number": "580-221-2022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS MEDICAL PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GENESIS MEDICAL PLLC",
        "enumeration_date": "2026-10-21",
        "last_updated": "2026-10-21",
        "certification_date": "2026-10-21",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "SHERRY",
        "authorized_official_middle_name": "LYNNE",
        "authorized_official_title_or_position": "CREDENTIALING, BILLING",
        "authorized_official_telephone_number": "580-223-5180"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Southern Oklahoma Pain Management",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Durant, OK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2026; 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.