GENESIS MEDICAL GROUP, LLC. (NPI# 1740538115) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1740538115 |
| Entity Type | Organization |
| Organization Name | GENESIS MEDICAL GROUP, LLC. |
| Practice Address |
1515 Nw 18th Ave Suite 100 Portland OR 97209-2516 |
| Mailing Address |
16679 Boones Ferry Rd 215 Lake Oswego OR 97035-4365 |
| Practice Telephone | 5036991911 |
| Practice Fax Number | 5036991912 |
| Mailing Telephone | 5036991911 |
| Mailing Fax Number | 5036991912 |
| Enumeration Date | 2012-08-16 |
| Last Update Date | 2012-08-16 |
| Authorized Official Name | WYATT J BROWN (DIRECTOR OF OPERATION) |
| Authorized Official Telephone | 5036991911 |
| Authorized Official Credential | CPED |
| Is Organization Subpart | Y |
| Parent Organization Name | GENESIS MEDICAL GROUP, LLC. |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 335E00000X | Prosthetic/Orthotic Supplier | Suppliers |
| 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 |
| 1457517138 | Genesis Medical Group, LLC. | Prosthetic/Orthotic Supplier | 16679 Boones Ferry Rd Ste 215, Lake Oswego, OR 97035-4368 | 2008-08-01 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Washington State Corporations | GENESIS MEDICAL GROUP, LLC | 10910 Domain Dr, Ste 300, Austin, TX 78758-7807 |
| Street Address |
1515 NW 18TH AVE SUITE 100 |
| City | PORTLAND |
| State | OR |
| Zip Code | 97209-2516 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245230952 | Leo Francis Quinn Jr. | Physical Therapist | 1515 Nw 18th Ave, Ste 400, Portland, OR 97209-2515 | 2005-07-22 |
| 1316497928 | Orthopedic & Sports Medicine Center of Or LLC | Physician Assistant | 1515 Nw 18th Ave, #300, Portland, OR 97209-2516 | 2016-10-06 |
| 1588076954 | Rose City Physical Therapy Associates, LLC | Clinic/Center | 1515 Nw 18th Ave, Suite 400, Portland, OR 97209-2516 | 2014-05-20 |
| 1851645121 | Suzanne Chi | Acupuncturist | 1515 Nw 18th Ave, Suite 400, Portland, OR 97209-2516 | 2012-11-07 |
| 1245482280 | Northwest Ambulatory Surgery Center LLC | Clinic/Center | 1515 Nw 18th Ave, Ste 200, Portland, OR 97209-2516 | 2008-10-22 |
| 1225293285 | Emily C Nguyen | Orthopaedic Surgery | 1515 Nw 18th Ave, Ste 300, Portland, OR 97209-2539 | 2008-07-18 |
| 1750420063 | Pettygrove Physical Therpay Associates LLC | Physical Therapist | 1515 Nw 18th Ave, Suite 400, Portland, OR 97123 | 2007-02-05 |
| 1376600049 | Barry A Jacoshenk | Physician Assistant | 1515 Nw 18th Ave, Suite 300, Portland, OR 97209-2516 | 2007-01-02 |
| 1376579631 | Justin Robert Thibeault | Physician Assistant | 1515 Nw 18th Ave, 3rd Floor, Portland, OR 97209-2516 | 2006-06-25 |
| 1235179656 | Derek Edward Lamprecht | Orthopaedic Surgery | 1515 Nw 18th Ave, Suite 300, Portland, OR 97209-2515 | 2006-06-07 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508476250 | Harrington Health Clinic | Nurse Practitioner | 310 Nw Glisan Street, Portland, OR 97209 | 2020-08-07 |
| 1619599636 | Rivers Way Training Clinic | Community/Behavioral Health | 2049 Nw Hoyt, Portland, OR 97209 | 2020-05-13 |
| 1518590538 | Julie Kay Igarta | Registered Nurse | 140 Northwest 14th Avenue, Portland, OR 97209 | 2020-02-18 |
| 1407492002 | Oregon Injection Clinic | Clinic/Center | 1500 Nw Lovejoy, 106, Portland, OR 97209 | 2019-11-19 |
| 1487202883 | Ann Tesora | Massage Therapist | 1320 Northwest 20th Avenue, Portland, OR 97209 | 2019-08-28 |
| 1972160455 | Vincent Martin | Massage Therapist | 210 Sw 17th Avenue, Portland, OR 97209 | 2019-05-21 |
| 1154896546 | Jennifer Marie Dodd | Social Worker | 1722 Nw Raleigh St Spc 412, Portland, OR 97209 | 2018-10-11 |
| 1922551910 | Ashley Crowell | Physician Assistant | 949 Nw Overton St Unit 306, Portland, OR 97209 | 2016-07-26 |
| 1326408394 | Jennifer Blain | Counselor | 324 Nw Davis, Portland, OR 97209 | 2016-03-03 |
| 1275993255 | Lauren Dodson | Licensed Practical Nurse | 324 Nw Davis St, Portland, OR 97209 | 2016-03-03 |
| Find all providers in zip 97209 | ||||
| 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 |
|---|---|---|---|---|
| 1194023218 | Aryz Inc | Prosthetic/Orthotic Supplier | 671 Forest Ave, Portland, ME 04103-4158 | 2011-03-14 |
| 1023188778 | Orthotic Prosthetic Associates, Inc. | Prosthetic/Orthotic Supplier | 173 Ne 102nd Ave, Portland, OR 97220-4169 | 2006-11-09 |
| 1659306207 | Nordstrom Inc & Subsidiaries | Prosthetic/Orthotic Supplier | 1001 Lloyd Ctr, Portland, OR 97232-1238 | 2006-07-12 |
| 1669407219 | Nordstrom Inc & Subsidiaries | Prosthetic/Orthotic Supplier | 701 Sw Broadway, Portland, OR 97015-3301 | 2006-07-12 |
| 1902831563 | Nordstrom Inc & Subsidiaries | Prosthetic/Orthotic Supplier | 11900 Se 82nd Ave, Portland, OR 97086-7724 | 2006-07-12 |
| 1629003280 | Nordstrom Inc & Subsidiaries | Prosthetic/Orthotic Supplier | 9700 Sw Washington Square Rd, Portland, OR 97223-4453 | 2006-07-12 |
| 1265481758 | A Step Forward LLC | Prosthetic/Orthotic Supplier | 8605 Sw Terwilliger Blvd, Portland, OR 97219-4565 | 2006-05-10 |
| 1386602621 | East Side Orthotics & Prosthetics | Prosthetic/Orthotic Supplier | 17316 Ne Halsey St, Portland, OR 97230-6026 | 2006-05-03 |
| 1407811789 | Oregon Artificial Limb Co. | Prosthetic/Orthotic Supplier | 21 Ne Seventh Ave., Portland, OR 97232-2907 | 2006-04-19 |
| 1033112636 | Oregon Pedorthic Services | Prosthetic/Orthotic Supplier | 9932 Ne Halsey St, Portland, OR 97220-4474 | 2005-05-27 |
| Find all providers in PORTLAND | ||||
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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.