GENESIS ELDERCARE PHYSICIAN SERVICES LLC


Address: 1 Emerson Dr, Kimberly Hall North, Windsor, CT 06095
Phone: 8606886443

GENESIS ELDERCARE PHYSICIAN SERVICES LLC (NPI# 1164415196) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1164415196
Entity Type Organization
Organization Name GENESIS ELDERCARE PHYSICIAN SERVICES LLC
Practice Address 1 Emerson Dr
Kimberly Hall North
Windsor
CT 06095
Mailing Address Po Box 62946
Baltimore
MD 21264-2946
Practice Telephone 8606886443
Practice Fax Number 8606885230
Mailing Telephone 4104947607
Mailing Fax Number 6109257387
Enumeration Date 2005-08-24
Last Update Date 2019-08-05
Authorized Official Name ERIC SHAPIRO (VP, AREA CONTROLLER)
Authorized Official Telephone 4108327790
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
N 207R00000X Internal Medicine Allopathic & Osteopathic Physicians
Y 207RG0300X Internal Medicine
Specialization: Geriatric Medicine
CT Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
CT 004126919 05
CT 004195021 05

Other Provider IDs and Locations

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
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
1659737898 Genesis Eldercare Physician Services LLC Internal Medicine 515 Fairmount Ave, Towson, MD 21286-5466 2016-01-04

Other Data Sources

Entity Type Entity Name Entity Address
Washington State Corporations GENESIS ELDERCARE PHYSICIAN SERVICES LLC 101 E State St, Kennett Sq, PA 19348-3109

Office Location

Street Address 1 EMERSON DR
KIMBERLY HALL NORTH
City WINDSOR
State CT
Zip Code 06095

Providers in the same location

NPI Name Taxonomy Address Enumeration
1598377251 Amanda Archambault Speech-Language Pathologist 1 Emerson Dr, Windsor, CT 06095-3204 2020-08-23
1285259481 Jenna Ann Borrmann Physical Therapy Assistant 1 Emerson Dr, Windsor, CT 06095-3200 2020-06-12
1295378586 Kristen Marie Shaw Physical Therapist 1 Emerson Dr, Windsor, CT 06095-3204 2019-10-20
1669946588 Olusegun Olaosebikan Nurse Practitioner 1 Emerson Dr, Windsor, CT 06095-3204 2019-01-14
1336631183 Andrew Gray Physical Therapy Assistant 1 Emerson Dr, Windsor, CT 06095-3204 2018-06-06
1447764097 Ishani Ravi Patel Physical Therapist 1 Emerson Dr, Windsor, CT 06095-3204 2017-11-18
1790295772 Melissa Lynn Bourgeois Physical Therapist 1 Emerson Dr, Windsor, CT 06095-3204 2017-10-04
1275050791 Amy Mccracken Speech-Language Pathologist 1 Emerson Dr, Windsor, CT 06095-3204 2017-08-25
1285157339 Tara Gehring Physical Therapy Assistant 1 Emerson Dr, Windsor, CT 06095-3204 2017-07-20
1679005656 Luisell M Velazquez Occupational Therapy Assistant 1 Emerson Dr, Windsor, CT 06095-3204 2017-03-30
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1285255992 Dnd Group of Companies LLC Psychologist 204 Old Village Cir, Windsor, CT 06095 2020-05-04
1811467442 Joseph C Gaetani Jr. Specialist 340 Broad Street Suite 320, Windsor, CT 06095 2018-11-27
1447629043 Brittany Higginbotham Marriage & Family Therapist 347 Park Avenue, Windsor, CT 06095 2015-09-24
1457737454 Eric Han Dentist 697 Poquonock Ave, Windsor, CT 06095 2015-08-03
1265780894 Annetta Ruth Troche Nurse Practitioner 22 Parkwood Drive, Windsor, CT 06095 2012-08-29
1821234006 Milna Rosario Social Worker 6 Poquonock Avenue, Windsor, CT 06095 2008-12-18
1962686824 Kimberly Ju Kim Pediatrics 820 C Prospect Hill Road, Windsor, CT 06095 2007-12-27
1972708758 Price Chopper Inc Pharmacy 675 Poquoncock Ave, Windsor, CT 06095 2007-06-20
1396870358 Occupational Health Centers of The Southwest, P.a., P.C. Clinic/Center 1080 Day Hill Road, Windsor, CT 06095 2007-02-22
1841342094 Thomas F. Reif Psychologist 32 Maple Avenue, Windsor, CT 06095 2007-01-17
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Taxonomy Information

Taxonomy Code 207RG0300X
Grouping Allopathic & Osteopathic Physicians
Classification Internal Medicine
Specialization Geriatric Medicine

Taxonomy Definition

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.

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1427612100 Holistic Healing Partners, LLC Internal Medicine 290 Baxter Ln, Milford, CT 06460-6813 2019-04-28
1003113762 Jennifer Anne Freimund Internal Medicine 1450 Chapel St Ste 107, New Haven, CT 06511-4405 2011-02-16
1720211444 Joseph Daniel Demayo Internal Medicine 66 Skyline Dr, Middlebury, CT 06762-1717 2009-08-27
1679701882 Southern Connecticut Geriatric & Preventive Medicine LLC Internal Medicine 4 Sagamore Cove Rd, Branford, CT 06405-5020 2009-06-25
1184896151 Geriatric Medicine Consultants Home Visit Practice, LLC Internal Medicine 33 Birch Rd, West Hartford, CT 06119-1009 2008-03-30
1083814339 Lefkowitz & Scollan, M.d.'s,llc Internal Medicine 469 E Main St, Meriden, CT 06450-6027 2007-07-24
1326116948 Barney Spivack Internal Medicine 101 Long Lots Rd, Westport, CT 06880-3919 2006-12-01
1447267026 Casey Ott Internal Medicine 22 Old Waterbury Rd # 103, Southbury, CT 06488-3848 2006-08-03
1447264155 Audrey Lefkowitz Internal Medicine 469 E Main Street, Meriden, CT 06450 2006-07-28
1477583540 Geraldine M Fabregas Internal Medicine 280 Alden Ave, New Haven, CT 06515-2114 2006-07-04
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Competitor

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City WINDSOR
Zip Code 06095

Improve Information

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Dataset Information

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.

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