Individual provider Active NPI

Michael James Gennrich, M.D.

  • Pediatrics Physician
  • Austin, TX
National Provider Identifier
1609087899
Registry record updated Jun 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
N1325 Issued in TX
Practice address
4515 Seton Center Pkwy
#220
Austin, TX 78759
Phone
(512) 338-8388
Fax
(512) 338-8430
NPI assigned
May 27, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 27, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X N1325 TX Primary

Addresses

Primary practice location

4515 Seton Center Pkwy
#220
Austin, TX 78759

Mailing address

PO Box 26726
Austin, TX 78755-0726
Phone (512) 407-8686

Other identifiers 3

IdentifierTypeStateIssuer
197715908MedicaidTX
197715909MedicaidTX
197715910MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130114000077 TX Practitioner - Pediatric Medicine 0547357832 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Pediatric Medicine
Education
University of Wisconsin School of Medicine, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Austin Regional Clinic PAGroup PAC ID 3072507789, 398 clinicians

Practice addresses (Care Compare)

4515 Seton Ctr Pkwy
220 Arc Quarry Lake
Austin, TX 78759-5784
Phone (512) 338-8388

6835 Austin Ctr Blvd
Austin, TX 78731-3166
Phone (512) 346-6611

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
N1325TXMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Austin Regional Clinic, PA Pediatrics CurrentSince Jan 15, 2013 Accepting new patients
Austin Regional Clinic, PA CurrentSince Jan 15, 2013 Accepting new patients
Austin Regional Clinic, PA Past Accepting new patients

Locations

4515 Seton Center Pkwy
Ste 220
Austin, TX 78759
Phone (512) 338-8388

6835 Austin Center Blvd
Austin, TX 78731
Phone (512) 231-5210

151 Exchange Blvd
Ste 500
Hutto, TX 78634
Phone (512) 846-1244

Interoperability endpoints

  • Direct secure messaging: mgennrich9657@arcmd.direct-ci.com

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1180224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1530057600000",
    "number": "1609087899",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26726",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787550726",
            "telephone_number": "512-407-8686",
            "fax_number": "512-406-6216"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4515 SETON CENTER PKWY",
            "address_2": "#220",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "78759",
            "telephone_number": "512-338-8388",
            "fax_number": "512-338-8430"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENNRICH",
        "first_name": "MICHAEL",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-27",
        "last_updated": "2018-06-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "N1325",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "197715908",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "197715909",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "197715910",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Austin, TX

Sources for this page

Verify at the official NPI Registry.