Edward Stanley Gensicki, DPM

Primary specialty

PodiatristTaxonomy code 213E00000X

License

P00369 Issued in CT

Practice address

1812 Dixwell Ave
Hamden, CT 06514-3105

Phone

(203) 287-0336

Fax

(203) 287-0387

NPI assigned

Jun 30, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 8

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Podiatry

Education

Kent State University College of Podiatric Medicine, 1984

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Staywell Health Care Inc.Group PAC ID 6305750480, 43 clinicians

Comprehensive Orthopedics and Musculoskeletal Care LLCGroup PAC ID 9830097864, 27 clinicians

Practice addresses (Care Compare)

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Comprehensive Orthopedics & Musculoskeletal Care LLC

  • Orthopaedic Surgery Physician
  • Wallingford, CT
  • NPI 1790844330
  Medicare reassignment Care Compare group NPD
• Staywell Health Care, Inc.

  • Family Medicine Physician
  • Waterbury, CT
  • NPI 1154342335
  Medicare reassignment Care Compare group NPD
• Edward S. Gensicki, D.P.M.

  • Customized Equipment (DME)
  • Hamden, CT
  • NPI 1255501748
  NPD Authorized official
• Saint Raphael Faculty Physicians

  • Internal Medicine Physician
  • New Haven, CT
  • NPI 1932138138
  NPD (past)

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203033600000",
    "number": "1982632634",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1812 DIXWELL AVE",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065143105",
            "telephone_number": "203-287-0336",
            "fax_number": "203-287-0387"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1812 DIXWELL AVE",
            "city": "HAMDEN",
            "state": "CT",
            "postal_code": "065143105",
            "telephone_number": "203-287-0336",
            "fax_number": "203-287-0387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GENSICKI",
        "first_name": "EDWARD",
        "middle_name": "STANLEY",
        "name_prefix": "Dr.",
        "credential": "DPM",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-30",
        "last_updated": "2008-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "213E00000X",
            "taxonomy_group": "",
            "desc": "Podiatrist",
            "state": "CT",
            "license": "P00369",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE",
            "identifier": "000369-7413",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "183481",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OXFORD",
            "identifier": "P778784",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004067245",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC",
            "identifier": "030000369CT01",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "P00369",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HEALTH NET",
            "identifier": "0V1575",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "4800009967",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Emily Gaudet, CGC
• Lucy Gauvin, ATC
• Christian Gee
• Roberta W Geisser, OTR/L
• Generations Obstetrics and Gynecology, PC
• Marguerite Gentile, L.C.S.W
• Gentle Journey Counseling Services
• Georgann Witte, PHD,LLC
• Jennifer C Gereda, LCSW
• Geriatric and Adult Psychiatry, LLC

• Podiatrist in Hamden, CT
• Providers in Hamden, CT by specialty
• Podiatrist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2008; 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.