GENESIS ELDERCARE PHYSICIAN SERVICES LLC (NPI# 1366840811) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1366840811 |
| Entity Type | Organization |
| Organization Name | GENESIS ELDERCARE PHYSICIAN SERVICES LLC |
| Practice Address |
1104 Wesley Ave Bryan OH 43506 |
| Mailing Address |
Po Box 62946 Baltimore MD 21264-2946 |
| Practice Telephone | 4196365071 |
| Mailing Telephone | 4104947607 |
| Enumeration Date | 2014-12-16 |
| Last Update Date | 2019-08-05 |
| Authorized Official Name | ERIC SHAPIRO (VICE PRESIDENT) |
| Authorized Official Telephone | 4108327790 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207RG0300X |
Internal Medicine Specialization: Geriatric Medicine |
201315000306 | OH | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801215041 | Genesis Eldercare Physician Services LLC | Family Medicine | 835 Tenderfoot Hill Rd # T, Colorado Springs, CO 80906 | 2014-04-15 |
| 1033535828 | Genesis Eldercare Physician Services LLC | Nurse Practitioner | 16605 Chestnut Glen Pl, Louisville, KY 40245 | 2014-03-17 |
| 1609180926 | Genesis Eldercare Physician Services LLC | Family Medicine | 6508 Deer Pointe Dr Ste A, Salisbury, MD 21804 | 2010-07-28 |
| 1326148107 | Genesis Eldercare Physician Services LLC | Skilled Nursing Facility | 14233 Alta Oaks Dr, Rockville, MD 20850-7413 | 2006-09-22 |
| 1699710202 | Genesis Eldercare Physician Services LLC | Internal Medicine | 11 Dairy Ln, Fredericksburg, VA 22405-2663 | 2006-06-18 |
| 1881635183 | Genesis Eldercare Physician Services LLC | Internal Medicine | 6508 Deer Pointe Dr, Suite A, Salisbury, MD 21804 | 2006-06-09 |
| 1104819259 | Genesis Eldercare Physician Services LLC | Internal Medicine | 464 Main St, Heritage Hall East, Agawam, MA 01001 | 2005-08-24 |
| 1164415196 | Genesis Eldercare Physician Services LLC | Internal Medicine | 1 Emerson Dr, Kimberly Hall North, Windsor, CT 06095 | 2005-08-24 |
| 1699280511 | Genesis Eldercare Physician Services LLC | Internal Medicine | 515 Fairmount Ave, Towson, MD 21286 | 2017-12-14 |
| 1548615313 | Genesis Eldercare Physician Services LLC | Internal Medicine | 7900 Constitution Ave Ne, Albuquerque, NM 87110 | 2016-04-29 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | GENESIS ELDERCARE PHYSICIAN SERVICES LLC | 101 E State St, Kennett Sq, PA 19348-3109 |
| Street Address |
1104 WESLEY AVE |
| City | BRYAN |
| State | OH |
| Zip Code | 43506 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134235880 | Harborside of Ohio Limited Partnership | Skilled Nursing Facility | 1104 Wesley Ave, Bryan, OH 43506-2579 | 2006-08-22 |
| 1922667914 | Bryan Snf, LLC | Skilled Nursing Facility | 1104 Wesley Ave, Bryan, OH 43506-2579 | 2019-06-12 |
| 1144887639 | Kendra Koester | Speech-Language Pathologist | 1104 Wesley Ave, Bryan, OH 43506-2579 | 2019-05-21 |
| 1629549043 | Katie Sue Moreland | Physical Therapy Assistant | 1104 Wesley Ave, Bryan, OH 43506-2579 | 2018-12-11 |
| 1992272983 | Rebecca Ann Powers | Occupational Therapy Assistant | 1104 Wesley Ave, Bryan, OH 43506-2579 | 2018-10-27 |
| 1578041794 | Jordan Spencer | Speech-Language Pathologist | 1104 Wesley Ave, Bryan, OH 43506-2579 | 2018-07-31 |
| 1336549013 | Jennifer Johnson | Residential Treatment Facility, Physical Disabilities | 1104 Wesley Ave, Bryan, OH 43506-2579 | 2014-08-29 |
| 1235547001 | Sara Dye | Physical Therapy Assistant | 1104 Wesley Ave, Bryan, OH 43506-2579 | 2014-07-24 |
| 1922410687 | Stephanie Nicole Allen | Nurse Practitioner | 1104 Wesley Ave, Bryan, OH 43506-2579 | 2014-05-28 |
| 1104242239 | Shauna Wright | Occupational Therapy Assistant | 1104 Wesley Ave, Bryan, OH 43506-2579 | 2014-03-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750883203 | Jennifer Spangler | Massage Therapist | 228 S. Main St., Bryan, OH 43506 | 2018-03-01 |
| 1922547215 | Alissa Niswonger | Specialist/Technologist | 106 Avenue B, Bryan, OH 43506 | 2017-02-20 |
| 1902140320 | Marcia Jean Slabaugh | Physical Therapy Assistant | 5299 County Road 1575, Bryan, OH 43506 | 2012-11-26 |
| 1215086640 | Filling Memorial Home Cardinal | Intermediate Care Facility, Mentally Retarded | 1211 Cardinal Drive, Bryan, OH 43506 | 2007-01-08 |
| 1396855714 | Williams County Transport | Ambulance | 05842 St Rt 15, Bryan, OH 43506 | 2006-08-30 |
| 1982635603 | Americare Health Services LLC | Durable Medical Equipment & Medical Supplies | 121 E South St, Bryan, OH 43506 | 2006-07-05 |
| 1174561963 | Richard U Baldwin | Emergency Medicine | 433 W. High St., Bryan, OH 43506 | 2006-06-03 |
| 1073595757 | Thomas A. Losey | Family Medicine | 442 West High Street, Midwest Community Health Associates, Bryan, OH 43506 | 2005-11-17 |
| 1841298296 | Claire Laree Osborn | Family Medicine | Activate Healthcare/500 W Mulberry St., Suite 101, Bryan, OH 43506 | 2005-07-11 |
| 1225519762 | Fountain City Chiropractic & Rehabilitation, Inc | Chiropractor | 1525 W High St, Ste A, Bryan, OH 43506 | 2018-08-23 |
| Find all providers in zip 43506 | ||||
| Taxonomy Code | 207RG0300X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Geriatric Medicine |
| An internist who has special knowledge of the aging process and special skills in the diagnostic, therapeutic, preventive and rehabilitative aspects of illness in the elderly. This specialist cares for geriatric patients in the patient's home, the office, long-term care settings such as nursing homes and the hospital. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source; 7/1/2011: modified source] - Additional Resources: American Board of Internal Medicine, 2007. http://www.abim.org/. American Osteopathic Board of Internal Medicine, 2007. http://www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Internal Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Internal Medicine. |
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| 1790343846 | Geriatric Care Providers Inc | Internal Medicine | 2605 Greenbrier Ct, Beavercreek, OH 45431-8564 | 2019-06-04 |
| 1538698568 | David John Donofrio | Internal Medicine | 6427 Stonecrest Dr, Brookpark, OH 44142-3767 | 2017-06-04 |
| 1346690757 | Detroit 74th Medical Clinic Inc | Internal Medicine | 4805 Lorain Ave, Cleveland, OH 44102-3351 | 2016-06-16 |
| 1245610179 | Sarah Hyun Hong Min | Internal Medicine | 2355 Norwood Ave Ste 1, Cincinnati, OH 45212-2750 | 2015-06-05 |
| 1326434127 | Hiba Khan | Internal Medicine | 1950 E 89th Street, Cleveland, OH 44195-1003 | 2015-04-09 |
| 1184927287 | Range Health Care Services LLC | Internal Medicine | 4875 Union Rd, Franklin, OH 45005-5127 | 2010-12-10 |
| 1366622623 | Peter Dillard Md Inc | Internal Medicine | 3237 Ormond Rd, Cleveland Heights, OH 44118-3415 | 2007-11-05 |
| 1427261692 | Preeti Betkerur | Internal Medicine | 75th Arch St, Suite G 2, Akron, OH 44304 | 2007-05-07 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.