GENESIS FAMILY PRACTICE, LLC
NPI 1023369204
Family Medicine in Orange City, FL
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
Specialties & Licenses 2
Secondary Practice Location 1
Other Identifiers 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Genesis Family Practice, Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
6Medicare enrollment records show 6 clinicians reassign Medicare billing to Genesis Family Practice, LLC, which bills Medicare for the services they deliver. Of these, 1 practice at this address and 2 within 10 miles. They are listed nearest first.
Clinicians, nearest first (6)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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, FLFrequently 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.
Is Genesis Family Practice, LLC enrolled in Medicare?
Yes. Genesis Family Practice, LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Genesis Family Practice, LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 6 clinicians in 3 Medicare specialties reassign their Medicare billing to Genesis Family Practice, LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. The largest specialties are General Practice (3), Nurse Practitioner (2) and Family Practice (1). Of these, 1 practice at this address and 2 within 10 miles. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
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 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 weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Genesis Family Practice, Llc · NPI 1023369204
Family Medicine organization in Orange City, Florida. Organization record, active in the CMS NPPES registry since September 27, 2012.
## Identity
- **NPI:** 1023369204 (Entity type: Organization)
- **Enumerated:** September 27, 2012
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Jay Chanmugam, OWNER
## Practice location
- **Address:** 1133 SAXON BLVD, Orange City, FL 32763-8425
- **Phone:** (386) 228-9700
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 6 clinicians in 3 Medicare specialties reassign Medicare billing to this organization (form CMS-855R); largest: General Practice (3), Nurse Practitioner (2), Family Practice (1); 1 practice at this address and 2 within 10 miles · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 28, 2022
- **Other identifiers:** Medicaid 008488100 (FL)
- **CLIA laboratory certificates:** 1 on file
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Source: [NPI Profile](https://npiprofile.com/npi/1023369204) · Data from the CMS NPPES public registry.