Genesis Health System
Organization Active NPI Family Medicine Physician · Davenport, IA
NPI 1922012764 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1922012764
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- Legal business name
- GENESIS HEALTH SYSTEM
- Practice address
- 1345 W Central Park Ave
Davenport, IA 52804-1844 - Phone
- (563) 421-4400
- Fax
- (563) 421-4449
- NPI assigned
- Jul 28, 2006
- Organization subpart
- No
Authorized official
- Name
- Ms. Terri Walz
- Title
- Program Assistant
- Phone
- (563) 421-4400
Other NPIs on the same Medicare enrollment 16
Practitioners 48
-
Kurt A Andersen, MD
-
Gena L.R. Benoit, MD
-
Valerie Lynne Bonnett, M.D.
-
Sarah Mae Brown, ARNP
-
Dean A Bunting, MD
-
Katrina Terese Cannon, MD, MS, CMD
-
Carla Rose Cloos, M.D.
-
Jason Cort Hagemann, D.O.
-
Anna M Hansen, PA-C
-
Mark A Hull, MD
-
Linda Malizia Jager, M.D.
-
Bradley W Johnson, D.O
-
Michael J Kelly, MD
-
Angela Marie Kerchner, M.D.
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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | Yes |
Addresses
Primary practice location
1345 W Central Park Ave
Davenport, IA 52804-1844
Mailing address
1345 W Central Park Ave
Davenport, IA 52804-1844
Phone (563) 421-4400
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0495747 | Medicaid | IA | |
| 0495952 | Medicaid | IA |
Other names
- Genesis Family Medical Center
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 Medical Center
All providers in Davenport, IA · Family Medicine 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 Aug 22, 2020. 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.