NPIMap

Organization Active NPI

The Genesis Company, LLC

  • Phlebology Physician
  • Jefferson City, MO
National Provider Identifier
1609382159
Registry record updated Jun 16, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Phlebology PhysicianTaxonomy code 202K00000X
Legal business name
THE GENESIS COMPANY, LLC
Doing business as
Genesis Laser and Vein Center
Practice address
2511 W Edgewood Dr Ste H
Jefferson City, MO 65109-5869
Phone
(573) 761-5277
NPI assigned
Dec 20, 2017
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2018

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

Authorized official

Name
Chandra Nath Prasad, MDNPI 1962488098
Title
Owner
Phone
(573) 761-5277

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Phlebology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 202K00000X Primary

Addresses

Primary practice location

2511 W Edgewood Dr Ste H
Jefferson City, MO 65109-5869

Mailing address

2511 W Edgewood Dr Ste H
Jefferson City, MO 65109-5869
Phone (573) 761-5277

Other names 1

  • Genesis Laser and Vein Center Doing business as

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20180228002009 MO Part B Supplier - Clinic/Group Practice 8224399563 Receives reassigned benefits from 4 practitioners
Practice locations: Jefferson City, MO

National Provider Directory

National Provider Directory

Locations

2511 W Edgewood Dr
Jefferson City, MO 65109
Phone (573) 761-0304

2511 W Edgewood Dr
Ste H
Jefferson Cty, MO 65109
Phone (573) 761-5277

Practitioners & affiliated clinicians

Practitioners 4

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

NPI Registry JSON

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

{
    "created_epoch": "1513728000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1609382159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2511 W EDGEWOOD DR STE H",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651095869",
            "telephone_number": "573-761-5277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2511 W EDGEWOOD DR STE H",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651095869",
            "telephone_number": "573-761-5277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE GENESIS COMPANY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-20",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "PRASAD",
        "authorized_official_first_name": "CHANDRA",
        "authorized_official_middle_name": "NATH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "573-761-5277",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "202K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Phlebology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Genesis Laser and Vein Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Jefferson City, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.