Active NPI
Gregory P Genova, M.D.
- Internal Medicine Physician
- O'Fallon, MO
National Provider Identifier
1750377941
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- MDR3C40
- Practice address
- 5551 Winghaven Blvd Ste 250
O Fallon, MO 63368-3630 - Phone
- (636) 685-7724
- Fax
- (314) 590-5914
- NPI assigned
- Sep 22, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | MDR3C40 | MO | Primary |
Addresses
Primary practice location
5551 Winghaven Blvd Ste 250
O Fallon, MO 63368-3630
Mailing address
5551 Winghaven Blvd
Suite 132
O Fallon, MO 63368-3617
Phone (636) 695-2520
Other practice location 1
224 S Woods Mill Rd Ste 450
Chesterfield, MO 63017-3513
Phone (636) 695-2520
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 110229354 | Other | MO | RR MEDICARE |
| P00254751 | Other | MO | RR MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MDR3C40 | MO | MD | Internal Medicine Physician |
Interoperability endpoints
- gregory.genova.p1@direct.phcenters.nextgenshare.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1127347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598313600000",
"number": "1750377941",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5551 WINGHAVEN BLVD",
"address_2": "SUITE 132",
"city": "O FALLON",
"state": "MO",
"postal_code": "633683617",
"telephone_number": "636-695-2520",
"fax_number": "636-695-2526"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5551 WINGHAVEN BLVD STE 250",
"city": "O FALLON",
"state": "MO",
"postal_code": "633683630",
"telephone_number": "636-685-7724",
"fax_number": "314-590-5914"
}
],
"practiceLocations": [
{
"address_1": "224 S Woods Mill Rd Ste 450",
"address_purpose": "LOCATION",
"city": "Chesterfield",
"state": "MO",
"postal_code": "630173513",
"country_code": "US",
"telephone_number": "636-695-2520",
"fax_number": "314-590-5925",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GENOVA",
"first_name": "GREGORY",
"middle_name": "P",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-09-22",
"last_updated": "2020-08-25",
"certification_date": "2020-08-25",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "MO",
"license": "MDR3C40",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "110229354",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RR MEDICARE",
"identifier": "P00254751",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in O'Fallon, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 25, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.