NPIMap

Organization Active NPI

Genesis Medical Group, LLC.

  • Prosthetic/Orthotic Supplier
  • Portland, OR
National Provider Identifier
1740538115
Registry record updated Aug 16, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prosthetic/Orthotic SupplierTaxonomy code 335E00000X
Legal business name
GENESIS MEDICAL GROUP, LLC.
Practice address
1515 NW 18TH Ave
Suite 100
Portland, OR 97209-2516
Phone
(503) 699-1911
Fax
(503) 699-1912
NPI assigned
Aug 16, 2012
Organization subpart
Yes
Parent organization
GENESIS MEDICAL GROUP, LLC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Aug 16, 2012

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

Authorized official

Name
Wyatt J Brown, CPED
Title
Director of Operation
Phone
(503) 699-1911

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prosthetic/Orthotic Supplier 335E00000X Primary

Addresses

Primary practice location

1515 NW 18TH Ave
Suite 100
Portland, OR 97209-2516

Mailing address

16679 Boones Ferry Rd
215
Lake Oswego, OR 97035-4365
Phone (503) 699-1911

National Provider Directory

National Provider Directory
Tax ID family
Genesis Medical Group LLC2 organizations share this tax ID, including this one
Part of
Genesis Medical Group LLC

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

NPI Registry JSON

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

{
    "created_epoch": "1345075200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1345075200000",
    "number": "1740538115",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "16679 BOONES FERRY RD",
            "address_2": "215",
            "city": "LAKE OSWEGO",
            "state": "OR",
            "postal_code": "970354365",
            "telephone_number": "503-699-1911",
            "fax_number": "503-699-1912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 NW 18TH AVE",
            "address_2": "SUITE 100",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972092516",
            "telephone_number": "503-699-1911",
            "fax_number": "503-699-1912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS MEDICAL GROUP, LLC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "GENESIS MEDICAL GROUP, LLC.",
        "enumeration_date": "2012-08-16",
        "last_updated": "2012-08-16",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "WYATT",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATION",
        "authorized_official_telephone_number": "503-699-1911",
        "authorized_official_credential": "CPED"
    },
    "taxonomies": [
        {
            "code": "335E00000X",
            "taxonomy_group": "",
            "desc": "Prosthetic/Orthotic Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2012; 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.