Genesis Health System
Organization Active NPI Physical Therapy Clinic/Center · Coralville, IA
NPI 1902107261 · NPPES record last updated Nov 3, 2010
Key facts
- NPI
- 1902107261
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Physical Therapy Clinic/Center 261QP2000X
- Legal business name
- GENESIS HEALTH SYSTEM
- Practice address
- 2451 Coral CT
Suite 1
Coralville, IA 52241-2837 - Phone
- (563) 421-9580
- NPI assigned
- Nov 3, 2010
- Organization subpart
- No
Authorized official
- Name
- Mark G. Rogers
- Title
- Cfo
- Phone
- (563) 421-6513
Other NPIs on the same Medicare enrollment 16
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
2451 Coral Ct
Ste 1
Coralville, IA 52241
Phone (319) 853-0596
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Clinic/Center | 261QP2000X | Yes |
Addresses
Primary practice location
2451 Coral CT
Suite 1
Coralville, IA 52241-2837
Mailing address
865 Lincoln Rd
Suite L10
Bettendorf, IA 52722-4190
Phone (563) 355-9200
Other names
- Genesis Pediatric Physical Therapy Clinic
NPI Registry JSON
{
"created_epoch": "1288742400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1288742400000",
"number": "1902107261",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "865 LINCOLN RD",
"address_2": "SUITE L10",
"city": "BETTENDORF",
"state": "IA",
"postal_code": "527224190",
"telephone_number": "563-355-9200",
"fax_number": "563-355-3419"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2451 CORAL CT",
"address_2": "SUITE 1",
"city": "CORALVILLE",
"state": "IA",
"postal_code": "522412837",
"telephone_number": "563-421-9580"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GENESIS HEALTH SYSTEM",
"organizational_subpart": "NO",
"enumeration_date": "2010-11-03",
"last_updated": "2010-11-03",
"status": "A",
"authorized_official_last_name": "ROGERS",
"authorized_official_first_name": "MARK",
"authorized_official_middle_name": "G.",
"authorized_official_title_or_position": "CFO",
"authorized_official_telephone_number": "563-421-6513"
},
"taxonomies": [
{
"code": "261QP2000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Physical Therapy",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Genesis Pediatric Physical Therapy Clinic",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Coralville, IA
- Kirk Kendal Garmager
- Jeff Garner
- Patricia Lynn Gasmi
- Sydnee Gatewood
- Sarah Gauger
- Patricia Genus
- Amanda Gernant
- Dana Ghazaleh
- Kirk R Gieswein
- Gregory Alan Gilbaugh
All providers in Coralville, IA · Physical Therapy Clinic/Center in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 2010. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.