Genesis Surgery Center

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

336817 Issued in MI

Legal business name

GENESIS SURGERY CENTER

Practice address

3400 E Jolly Rd
Lansing, MI 48910-8542

Phone

(517) 272-1063

Fax

(517) 272-1685

NPI assigned

Mar 7, 2006

Last updated

Mar 13, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. David Destrisac, MD

Title

Medical Director

Phone

(517) 272-1063

Specialties & licenses 1

Addresses

Other identifiers 2

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

CLIA laboratory certificates

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

{
    "created_epoch": "1141689600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1205366400000",
    "number": "1578530630",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3400 E JOLLY RD",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489108542",
            "telephone_number": "517-272-1063",
            "fax_number": "517-272-1685"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3400 E JOLLY RD",
            "city": "LANSING",
            "state": "MI",
            "postal_code": "489108542",
            "telephone_number": "517-272-1063",
            "fax_number": "517-272-1685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS SURGERY CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-07",
        "last_updated": "2008-03-13",
        "status": "A",
        "authorized_official_last_name": "DESTRISAC",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "517-272-1063",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "MI",
            "license": "336817",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS-2ND",
            "identifier": "0C37001",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "40369",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• General Dentistry of Michigan 1 PLLC
• Genesis ASC Partners LLC
• Genesis Diagnostic Center Inc
• Genesis Group Practice PLLC
• Genesis Home Healthcare Providers, LLC
• Genesis Testing and Therapy
• Carli Gengler, BA
• Ryan Gennette, NP-C
• Genoa Healthcare LLC
• Angela Genova, CRNA

• Ambulatory Surgical Clinic/Center in Lansing, MI
• Providers in Lansing, MI by specialty
• Ambulatory Surgical Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• 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.