NPIMap

Organization Active NPI

Genesis Pediatric Medicine, LLC

  • Pediatrics Physician
  • Sycamore, IL
National Provider Identifier
1912295494
Registry record updated Jul 18, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
036097453 Issued in IL
Legal business name
GENESIS PEDIATRIC MEDICINE, LLC
Practice address
1830 Mediterranean Dr
Sycamore, IL 60178-3144
Phone
(815) 899-0001
Fax
(815) 899-0002
NPI assigned
Jul 18, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2011

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

Authorized official

Name
Dr. Mark Alan Regnier, M.D.NPI 1851398663
Title
President
Phone
(815) 899-0001

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 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X 036097453 IL Primary

Addresses

Primary practice location

1830 Mediterranean Dr
Sycamore, IL 60178-3144

Mailing address

1830 Mediterranean Dr
Sycamore, IL 60178-3144
Phone (815) 899-0001

Other identifiers 1

IdentifierTypeStateIssuer
036097453MedicaidIL

National Provider Directory

National Provider Directory

Locations

1680 Mediterranean Dr
Ste 107
Sycamore, IL 60178
Phone (815) 899-0001

1680 Mediterranean Dr
Sycamore, IL 60178
Phone (815) 899-0001

1830 Mediterranean Dr
Sycamore, IL 60178
Phone (815) 306-2700

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1310947200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1310947200000",
    "number": "1912295494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1830 MEDITERRANEAN DR",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783144",
            "telephone_number": "815-899-0001",
            "fax_number": "815-899-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1830 MEDITERRANEAN DR",
            "city": "SYCAMORE",
            "state": "IL",
            "postal_code": "601783144",
            "telephone_number": "815-899-0001",
            "fax_number": "815-899-0002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GENESIS PEDIATRIC MEDICINE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-07-18",
        "last_updated": "2011-07-18",
        "status": "A",
        "authorized_official_last_name": "REGNIER",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "ALAN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "815-899-0001",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036097453",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036097453",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sycamore, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2011; 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.