Genesis Health System
Organization Active NPI Physical Medicine & Rehabilitation Physician · Davenport, IA
NPI 1760434658 · NPPES record last updated Apr 27, 2009
Key facts
- NPI
- 1760434658
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Medicine & Rehabilitation Physician 208100000X
- Legal business name
- GENESIS HEALTH SYSTEM
- Practice address
- 1351 W Central Park Ave
420
Davenport, IA 52804-1853 - Phone
- (563) 421-4380
- Fax
- (563) 421-4389
- NPI assigned
- May 17, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Mark G. Rogers
- Title
- Vice President of Finance
- Phone
- (563) 421-6513
Other NPIs on the same Medicare enrollment 16
Practitioners 4
-
Joseph Earl Brooks, D.O., M.H.A.
-
Janice D Simmons, ARNP
-
Yuanhui Zhang, MD
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 16D2004428 | Genesis Medical Center | Certificate of waiver | Mar 3, 2028 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031113000044 | IA | Part B Supplier - Clinic/Group Practice | 7214841436 |
Receives reassigned benefits from 306 practitioners 16 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Bettendorf, IA; Davenport, IA; Eldridge, IA; Durant, IA; De Witt, IA |
National Provider Directory
Locations
1351 W Central Park Ave
#S420
Davenport, IA 52804
Phone (563) 421-4380
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Medicine & Rehabilitation Physician |
208100000X | Yes |
Addresses
Primary practice location
1351 W Central Park Ave
420
Davenport, IA 52804-1853
Mailing address
PO Box 310102
Des Moines, IA 50331-0001
Phone (563) 421-4380
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0401944 | Medicaid | IA |
Other names
- Genesis Medical Center - Physical Medicine and Rehabilitation
Other providers in Davenport, IA
- Genesis Health System
- Genesis Health System
- Genesis Health System
- Genesis Health System
- Genesis Health System
- Genesis Health System
- Genesis Health System
- Genesis Health System
- Genesis Health System
- Genesis Health System
All providers in Davenport, IA · Physical Medicine & Rehabilitation Physician in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 27, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.