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GENESIS FAMILY PRACTICE, LLC
NPI 1023369204
Family Medicine in Orange City, FL

Active since September 27, 2012CLIA 10D2079319 · Waiver
1133 SAXON BLVD, ORANGE CITY, FL 32763(386) 228-9700 Get Directions Write a Review

NPPES record last updated: November 28, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Nov 28, 2022, Nov 19, 2019, Apr 17, 2018 and 1 more (4 updates tracked since 2016).

About Genesis Family Practice, Llc NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

GENESIS FAMILY PRACTICE, LLC (NPI 1023369204) is a healthcare organization registered as a family medicine in Orange City, Florida and active in the NPI registry since September 2012. The organization holds a CLIA Waiver certificate valid through June 12, 2028, maintains a secondary practice location in Ormond Beach, and lists Jay Crossette Chanmugam, Owner, as its authorized official.

NPPES Registry Identity

NPI1023369204
Entity TypeOrganization
Primary Taxonomy207Q00000X
Legal Business NameGENESIS FAMILY PRACTICE, LLC
Location Address1133 SAXON BLVDOrange City, FL 32763-8425
Mailing Address1133 Saxon BlvdOrange City, FL 32763-8425 · (386) 878-4137 · Fax (386) 878-4293
Phone(386) 228-9700
Organization SubpartNo
Authorized OfficialJay Crossette ChanmugamOwner · (386) 878-4137
Enumeration DateSeptember 27, 2012
Last NPPES UpdateNovember 28, 20224 updates tracked since enumeration
NPPES CertifiedNovember 28, 2022
✔ NPI 1023369204 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in FL · OS8600
Definition

Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.

Also ListedClinical Medical LaboratoryTaxonomy 291U00000X
1133 SAXON BLVD, Orange City, FL 32763
Open in Google Maps ↗

Secondary Practice Location 1

Location 1800 S Nova Rd Ste IOrmond Beach, FL 32174-7362 · Phone (386) 228-9700

Other Identifiers 1

Medicaid008488100FL

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Superior HealthPlan, Ambetter Health, Ambetter of Alabama and more.Insurance ›

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 10D2079319

Genesis Family Practice · Orange City, FL
Active · expires Jun 12, 2028
CLIA Number10D2079319
Laboratory TypePhysician Office
Certificate Effective DateJune 13, 2026
Certificate Expiration DateJune 12, 2028
Laboratory DirectorJay C. Chanmugam
Laboratory Phone(386) 228-9700
Laboratory LocationGenesis Family Practice1133 Saxon Blvd Ste 200, Orange City, FL 32763
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

Other Providers at the Same Location NPPES 11

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

HOPE ARLYNE KING ARNP
Nurse Practitioner
1133 SAXON BLVD
ORANGE CITY, FL 32763
Volusia County (386) 878-4137
DOCS AT HOME, LLC
Home Health
1133 SAXON BLVD
ORANGE CITY, FL 32763
Volusia County (386) 774-5211
PHYSICAL MEDICINE AND REHABILITATION, PA
Physical Medicine & Rehabilitation
1133 SAXON BLVD
ORANGE CITY, FL 32763
Volusia County (386) 775-7080
PROMPT CARE OF CENTRAL FLORIDA LLC
Clinic/Center (Urgent Care)
1133 SAXON BLVD
ORANGE CITY, FL 32763
Volusia County (386) 878-4137
MR. JAY C CHANMUGAM DO
Emergency Medicine
1133 SAXON BLVD
ORANGE CITY, FL 32763
Volusia County (386) 228-9700
DIADIRA SALGADO SANTIAGO
Nurse Practitioner (Family)
1133 SAXON BLVD
ORANGE CITY, FL 32763
Volusia County (386) 228-9700
CHARMAINE ALECIA MARTIN-CLARKE FNP-C
Nurse Practitioner (Family)
1133 SAXON BLVD
ORANGE CITY, FL 32763
Volusia County (386) 878-4137
ANA I RIBEIRO ARNP
Nurse Practitioner (Primary Care)
1133 SAXON BLVD
ORANGE CITY, FL 32763
Volusia County (386) 228-9700

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Genesis Family Practice, LLC's NPI number?

The NPI number for Genesis Family Practice, LLC is 1023369204. It was assigned to this organization in the NPPES registry on September 27, 2012.

Where is Genesis Family Practice, LLC located?

Genesis Family Practice, LLC is located at 1133 Saxon Blvd, Orange City, FL 32763. The listed phone number is (386) 228-9700.

What is Genesis Family Practice, LLC's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Does Genesis Family Practice, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 10D2079319) is associated with this NPI, valid through June 12, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

What insurance does Genesis Family Practice, LLC accept?

Health plans from Ambetter Health, Ambetter from Superior HealthPlan, Ambetter of Alabama and Florida Blue (BlueCross BlueShield FL) list Genesis Family Practice, LLC as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Genesis Family Practice, LLC was last updated on November 28, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.