Active NPI
Genesis Health at Home LLC
- Home Health Agency
- Austin, TX
National Provider Identifier
1811663552
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- Legal business name
- GENESIS HEALTH AT HOME LLC
- Practice address
- 13785 Research Blvd Ste 125
Austin, TX 78750-1826 - Phone
- (512) 516-3466
- Fax
- (877) 554-0690
- NPI assigned
- Aug 22, 2021
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Daniel Suku Jezreel
- Title
- President
- Phone
- (512) 516-3466
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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Primary | ||
| In Home Supportive Care Agency | 253Z00000X |
Addresses
Primary practice location
13785 Research Blvd Ste 125
Austin, TX 78750-1826
Mailing address
3122 Argento PL
Cedar Park, TX 78613-4357
Phone (512) 516-3466
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220812002709 | TX | Part A Provider - Home Health Agency | 0042693764 | Practice locations: Austin, TX |
Home health agency certification: CCN 748065
- Legal name
- GENESIS HEALTH AT HOME LLC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Jan 19, 2023
- Last certification
- Jan 4, 2023
- Ownership / control type
- Proprietary
- Organization structure
- LLC
- Incorporated
- Aug 12, 2021 in TX
- Enrollment address
- 13785 Research Blvd
Ste 125
Austin, TX 78750-1826
Care Compare: Home health agency
Medicare Care Compare- Listed as
- Genesis Health at Home LLC
- Overall star rating
- Ownership
- Proprietary
- Certified
- Jan 19, 2023
- Medicare certification status
- Active
- Services
- Nursing, Medical social, Physical therapy, Speech pathology, Occupational therapy
National Provider Directory
National Provider DirectoryOwnership & related parties
All disclosed owners & managing parties 1
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Daniel Suku Jezreel | 5% Or Greater Direct Ownership Interest | Aug 12, 2021 | 100% |
| Corporate Director | Aug 12, 2021 | 100% | |
| W-2 Managing Employee | Aug 12, 2021 | 100% |
Practitioners & affiliated clinicians
Practitioners 1
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
-
- Physical Therapist
- Cedar Park, TX
- NPI 1063763787
Affiliated clinicians 7
Clinicians who list this facility as an affiliation in Medicare Care Compare.
-
- Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
- Bastrop, TX
- NPI 1821023003
Home health agency
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1629590400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1730764800000",
"number": "1811663552",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3122 ARGENTO PL",
"city": "CEDAR PARK",
"state": "TX",
"postal_code": "786134357",
"telephone_number": "512-516-3466"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13785 RESEARCH BLVD STE 125",
"city": "AUSTIN",
"state": "TX",
"postal_code": "787501826",
"telephone_number": "512-516-3466",
"fax_number": "877-554-0690"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GENESIS HEALTH AT HOME LLC",
"organizational_subpart": "NO",
"enumeration_date": "2021-08-22",
"last_updated": "2024-11-05",
"certification_date": "2024-11-03",
"status": "A",
"authorized_official_last_name": "JEZREEL",
"authorized_official_first_name": "DANIEL",
"authorized_official_middle_name": "SUKU",
"authorized_official_title_or_position": "PRESIDENT",
"authorized_official_telephone_number": "512-516-3466",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": null,
"license": null,
"primary": true
},
{
"code": "253Z00000X",
"taxonomy_group": "",
"desc": "In Home Supportive Care",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Austin, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.