NPIMap

Individual provider Active NPI

Genevieve M Maloney, MD

  • Family Medicine Physician
  • Sault Sainte Marie, MI
National Provider Identifier
1679518997
Registry record updated Nov 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
4301079452 Issued in MI
Practice address
2864 Ashmun St
Sault Sainte Marie, MI 49783-3740
Phone
(906) 632-5200
NPI assigned
Jun 19, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 21, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 01050953 IN
Family Medicine Physician 207Q00000X 4301079452 MI Primary

Addresses

Primary practice location

2864 Ashmun St
Sault Sainte Marie, MI 49783-3740

Mailing address

2864 Ashmun St
Sault Sainte Marie, MI 49783-3740
Phone (906) 632-5200

Other identifiers 3

IdentifierTypeStateIssuer
000000383666OtherINBLUE CROSS
000000580323OtherINBCBS
200183770MedicaidIN

Other names 1

  • Dr. Genevieve M Peterson Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
01050953INMDFamily Medicine Physician
4301079452MIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sault Tribe of Chippewa Indians Current Accepting new patients
Sault Tribe of Chippewa Indians Current Accepting new patients
Sault Tribe of Chippewa Indians Current Accepting new patients
Saint Joseph Regional Medical Center-South Bend Campus, Inc. Past Accepting new patients
Saint Joseph Community Hospital of Mishawaka Past Accepting new patients
Air Angels Inc Past Accepting new patients

Locations

2864 Ashmun St
Sault South Marie, MI 49783
Phone (906) 632-5200

Organizations & group practices 6

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": "1150675200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1321833600000",
    "number": "1679518997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2864 ASHMUN ST",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497833740",
            "telephone_number": "906-632-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2864 ASHMUN ST",
            "city": "SAULT SAINTE MARIE",
            "state": "MI",
            "postal_code": "497833740",
            "telephone_number": "906-632-5200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALONEY",
        "first_name": "GENEVIEVE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-19",
        "last_updated": "2011-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01050953",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301079452",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "000000383666",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "000000580323",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200183770",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GENEVIEVE",
            "last_name": "PETERSON",
            "middle_name": "M",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Sault Sainte Marie, MI

Sources for this page

Verify at the official NPI Registry.