Rod E Genck, PA

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

1963 Issued in AZ

Practice address

680 E Deuce of Clubs
Show Low, AZ 85901-4829

Phone

(480) 682-4118

Fax

(480) 682-4101

NPI assigned

Aug 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Banner Primary Care Physicians Arizona LLC

  • Primary Care Clinic/Center
  • Phoenix, AZ
  • NPI 1659640902

  AZ

  Medicare reassignment Care Compare group NPD
• Banner Primary Care Physicians Arizona LLC

  • Primary Care Clinic/Center
  • Phoenix, AZ
  • NPI 1790306066
  NPD
• Mountain View Family Practice

  • Family Medicine Physician
  • Show Low, AZ
  • NPI 1629091020

  Family Medicine

  NPD (past)
• Banner Health

  • Multi-Specialty Clinic/Center
  • Susanville, CA
  • NPI 1205267549
  NPD (past)

Specialty

Physician Assistant

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Banner Primary Care Physicians Arizona LLC 236 clinicians

Practice addresses (Care Compare)

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

{
    "created_epoch": "1156032000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1459382400000",
    "number": "1972618890",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15223 N 87TH ST",
            "address_2": "#110",
            "city": "SCOTTSDALE",
            "state": "AZ",
            "postal_code": "852602639",
            "telephone_number": "480-682-4100",
            "fax_number": "480-682-4101"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 E DEUCE OF CLUBS",
            "city": "SHOW LOW",
            "state": "AZ",
            "postal_code": "859014829",
            "telephone_number": "480-682-4118",
            "fax_number": "480-682-4101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENCK",
        "first_name": "ROD",
        "middle_name": "E",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-20",
        "last_updated": "2016-03-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "1963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "442294",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Simranjit Singh Galhotra, MD, MBA
• Deborah Kim Gardner, APRN, FNP
• Jordan Gardner
• Sarah Garfield
• Jody Marie Gaskill, LAC
• Genoa Healthcare LLC
• German Dobson CVS LLC
• German Dobson CVS LLC
• Ghulam Mustafa LLC
• Laura Rennie Gibson, CNM

• All providers in Show Low, AZ
• Family Medicine Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.

Verify at the official NPI Registry.