NPIMap

Organization Active NPI

RM Genesis Healthcare

Doing business as HealthSource

  • Health Maintenance Organization
  • Greensboro, NC
National Provider Identifier
1861558512
Registry record updated Nov 19, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Health Maintenance OrganizationTaxonomy code 302R00000X
License
2930 Issued in NC
Legal business name
RM GENESIS HEALTHCARE
Doing business as
HealthSource
Practice address
4518 W Market St Ste a
Greensboro, NC 27407-1543
Phone
(336) 235-4022
Fax
(336) 235-4023
NPI assigned
Dec 28, 2006
Last updated
Nov 19, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 19, 2009

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

Authorized official

Name
Dr. Roosevelt John Smith, DCNPI 1235235680
Title
Clinic Director
Phone
(336) 235-4022

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Health Maintenance Organization 302R00000X 2930 NC Primary

Addresses

Primary practice location

4518 W Market St Ste a
Greensboro, NC 27407-1543

Mailing address

4518 W Market St Ste a
Greensboro, NC 27407-1543
Phone (336) 235-4022

Other identifiers 6

IdentifierTypeStateIssuer
264096200OtherNCFEDERAL WORKERS COMP
617755OtherCIGNA
085AMOtherNCBLUE CROSS BLUE SHIELD
42898OtherNCPARTNERS
89085AMMedicaidNC
617755OtherNCUNITED HEALTH CARE

Other names 1

  • HealthSource Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1258588800000",
    "number": "1861558512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4518 W MARKET ST STE A",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274071543",
            "telephone_number": "336-235-4022",
            "fax_number": "336-235-4023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4518 W MARKET ST STE A",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274071543",
            "telephone_number": "336-235-4022",
            "fax_number": "336-235-4023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RM GENESIS HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2009-11-19",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "ROOSEVELT",
        "authorized_official_middle_name": "JOHN",
        "authorized_official_title_or_position": "CLINIC DIRECTOR",
        "authorized_official_telephone_number": "336-235-4022",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DC"
    },
    "taxonomies": [
        {
            "code": "302R00000X",
            "taxonomy_group": "",
            "desc": "Health Maintenance Organization",
            "state": "NC",
            "license": "2930",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FEDERAL WORKERS COMP",
            "identifier": "264096200",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "617755",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "085AM",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PARTNERS",
            "identifier": "42898",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "89085AM",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED HEALTH CARE",
            "identifier": "617755",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "HealthSource",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Greensboro, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2009; 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.