GENESIS MEDICAL GROUP, LLC. (NPI# 1457517138) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1457517138 |
Entity Type | Organization |
Organization Name | GENESIS MEDICAL GROUP, LLC. |
Practice Address |
16679 Boones Ferry Rd Ste 215 Lake Oswego OR 97035-4368 |
Practice Telephone | 5036991911 |
Practice Fax Number | 5036991912 |
Mailing Telephone | 5036991911 |
Mailing Fax Number | 5036991912 |
Enumeration Date | 2008-08-01 |
Last Update Date | 2012-04-03 |
Authorized Official Name | MR. WYATT JAMES BROWN (DIRECTOR OF OPERATION) |
Authorized Official Telephone | 5036991911 |
Authorized Official Credential | CPED |
Is Organization Subpart | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
Y | 335E00000X | Prosthetic/Orthotic Supplier | 1355445-0 | OR | Suppliers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
OR | BLUE CROSS BLUE SHIELD | 081911000 | 01 |
OR | 500608071 | 05 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1326290248 | Genesis Medical Group, LLC. | Prosthetic/Orthotic Supplier | 1338 Commerce Ave Ste D, Longview, WA 98632-3743 | 2008-10-22 |
1740538115 | Genesis Medical Group, LLC. | Prosthetic/Orthotic Supplier | 1515 Nw 18th Ave, Suite 100, Portland, OR 97209-2516 | 2012-08-16 |
Entity Type | Entity Name | Entity Address |
---|---|---|
Washington State Corporations | GENESIS MEDICAL GROUP, LLC | 10910 Domain Dr, Ste 300, Austin, TX 78758-7807 |
Street Address |
16679 BOONES FERRY RD STE 215 |
City | LAKE OSWEGO |
State | OR |
Zip Code | 97035-4368 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1932700127 | Teresa Siebenaler Scott | Social Worker | 3990 Sw Collins Way, Suite 202, Lake Owsego, OR 97035 | 2020-11-04 |
1528671567 | Martin Henry Lees | Internal Medicine | 14 Morningview Lane, Lake Oswego, OR 97035 | 2020-08-28 |
1356976187 | Premere Rehab LLC | Occupational Therapist | Infinity Rehab - The Springs At Lake Oswego, 3900 Kruse Way Pl, Lake Oswego, OR 97035 | 2020-03-12 |
1689212193 | Jennifer Chauvin | Nurse Practitioner | 20 Juarez Street, Lake Oswego, OR 97035 | 2019-12-16 |
1003396888 | Sarah Guenzburger | Physical Therapist | 3900 Kruse Way Pl, Lake Oswego, OR 97035 | 2018-08-21 |
1568964252 | Brett Johnson | Marriage & Family Therapist | 5655 Southwood Dr, Lake Oswego, OR 97035 | 2018-03-08 |
1912416561 | Michael Paul Long | Social Worker | 14523 Westlake Drive, Lake Oswego, Or 97035, Lake Oswego, OR 97035 | 2017-09-27 |
1467807859 | Misty Lohn | Nurse Practitioner | 5 Centerpointe Dr., Ste 600, Lake Oswego, OR 97035 | 2016-05-04 |
1326405473 | Kelsey Prince | Behavioral Analyst | 6400 Sw Rosewood St., Portland (lake Oswego), OR 97035 | 2016-01-20 |
1942683388 | Elizabeth Risberg Harrison | Massage Therapist | 190 Oswego Summit, Lake Oswego, OR 97035 | 2015-07-02 |
Find all providers in zip 97035 |
Taxonomy Code | 335E00000X |
Grouping | Suppliers |
Classification | Prosthetic/Orthotic Supplier |
An organization that provides prosthetic and orthotic care which may include, but is not limited to, patient evaluation, prosthesis or orthosis design, fabrication, fitting and modification to treat limb loss for purposes of restoring physiological function and/or cosmesis or to treat a neuromusculoskeletal disorder or acquired condition. |
Notes: Source: American Board for Certification in Orthotics, Prosthetics, and Pedorthics, Inc. [7/1/2010: modified, 7/1/2013: modified] Additional Resources: American Board for Certification in Orthotics, Prosthetics and Pedorthics, Inc., www.abcop.org and Board of Certification/Accreditation, International, www.bocusa.org. |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1992721294 | Pro-tech Sports Medicine, Inc. | Prosthetic/Orthotic Supplier | 16679 Boones Ferry Rd, Suite 215, Lake Oswego, OR 97035-4365 | 2006-07-14 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1811500705 | Synergy Medical Systems, LLC | Prosthetic/Orthotic Supplier | 19365 Sw 65th Ave Ste 210, Tualatin, OR 97062-9196 | 2020-08-28 |
1881007607 | Shannon Levin | Prosthetic/Orthotic Supplier | 441 Union St Ne, Salem, OR 97301-2458 | 2014-06-09 |
1174892640 | Cognitive Harmonics, Inc | Prosthetic/Orthotic Supplier | 2104 Hill Way, Medford, OR 97504-6208 | 2011-12-29 |
1841581717 | Pacific Footwear Company Inc | Prosthetic/Orthotic Supplier | 1150 Knutson Ave, Suite 12, Medford, OR 97504-3100 | 2011-04-27 |
1417257742 | A Step Forward LLC | Prosthetic/Orthotic Supplier | 744 Hawthorne Ave Ne, Salem, OR 97301-4675 | 2010-11-03 |
1467783761 | Elliott Pedorthic Care LLC | Prosthetic/Orthotic Supplier | 85084 Kensington Dr, Pleasant Hill, OR 97455-9621 | 2010-01-26 |
1780836049 | Angel Hair Foundation Inc | Prosthetic/Orthotic Supplier | 2783 Suncrest Ave, Eugene, OR 97405-5923 | 2008-10-17 |
1295986065 | Mirage Hair Systems, Inc. | Prosthetic/Orthotic Supplier | Suite 210 Oakway Ctr, Suite 210, Eugene, OR 97401-5618 | 2008-10-09 |
1518148105 | Paradox Walkfit Inc. | Prosthetic/Orthotic Supplier | 15532 Sw Pacific Hwy, Suite C1a, Tigard, OR 97224-3598 | 2007-11-24 |
1821286501 | Willamette Orthotics & Prosthetics LLC | Prosthetic/Orthotic Supplier | 333 Nw Larch Ave Ste 1, Redmond, OR 97756-1359 | 2007-10-09 |
Find all providers with the same taxonomy |
City | LAKE OSWEGO |
Zip Code | 97035 |
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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.