Genesis Family Practice, LLC
NPI 1023369204ActiveOrganization· Family Medicine· Orange City, FL
Family Medicine in Orange City, Florida, registered in NPPES in September 2012. The authorized official on file is Jay Crossette Chanmugam, D.O., Owner. Enrolled in Medicare as part b supplier - clinic/group practice.
Overview
| NPI | 1023369204 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Sep 27, 2012 |
| Last updated in NPPES | Nov 28, 2022 |
| Certified by provider | Nov 28, 2022 |
| Reactivated | Apr 17, 2018 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Family Medicine Primary | 207Q00000X | OS8600 | FL |
| Clinical Medical Laboratory | 291U00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 10, 2026 | No match | — |
| New York OMIG · Nov 10, 2026 | No match | — |
| Ohio Medicaid · Nov 10, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 10, 2026 | No match | — |
| Washington HCA · Nov 10, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Enrolled Part B Supplier - Clinic/Group Practice (FL) |
|---|
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