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GENESIS MEDICAL PRACTICE, PLLC
NPI 1205662004
Internal Medicine in Greensboro, NC

Active since September 10, 2024
1921 NEW GARDEN RD, GREENSBORO, NC 27410(919) 370-8188 Get Directions Write a Review

NPPES record last updated: September 10, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

About Genesis Medical Practice, Pllc NPPES

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

GENESIS MEDICAL PRACTICE, PLLC (NPI 1205662004) is a healthcare organization registered as an internal medicine in Greensboro, North Carolina and active in the NPI registry since September 2024. The organization lists Brian Shackleford, Owner, as its authorized official.

NPPES Registry Identity

NPI1205662004
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameGENESIS MEDICAL PRACTICE, PLLC
Location Address1921 NEW GARDEN RDGreensboro, NC 27410-2193
Mailing Address1921 New Garden Rd Apt I104Greensboro, NC 27410-2200
Phone(919) 370-8188
Organization SubpartNo
Authorized OfficialBrian ShacklefordOwner · (919) 370-8188
Enumeration DateSeptember 10, 2024
NPPES CertifiedSeptember 10, 2024
✔ NPI 1205662004 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
1921 NEW GARDEN RD, Greensboro, NC 27410
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Other Identifiers 1

Other7154047United Healthcare

Group Practice 1

Group TaxonomyThis provdier is a business group of one or more individual practitioners, all of who practice with the same area of specialization.193400000X SINGLE SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Blue Cross and Blue Shield of NC.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 Medical Practice, Pllc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Clinicians Billing Medicare Through This Organization

Medicare enrollment records show 1 clinician reassigns Medicare billing to Genesis Medical Practice, PLLC, which bills Medicare for the services this clinician delivers.

Clinician (1)

Brian Shackleford, MD
Hospitalist
NPI 1154777662
MEDICAL CENTER BLVD
Winston Salem, NC 27157
(336) 716-2011
✔ PECOS23 mi

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

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 Medical Practice, PLLC's NPI number?

The NPI number for Genesis Medical Practice, PLLC is 1205662004. It was assigned to this organization in the NPPES registry on September 10, 2024.

Where is Genesis Medical Practice, PLLC located?

Genesis Medical Practice, PLLC is located at 1921 New Garden Rd, Greensboro, NC 27410. The listed phone number is (919) 370-8188.

What is Genesis Medical Practice, PLLC's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

Is Genesis Medical Practice, PLLC enrolled in Medicare?

Yes. Genesis Medical Practice, PLLC is registered in the Medicare PECOS enrollment system.

How many clinicians bill Medicare through Genesis Medical Practice, PLLC?

According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Hospitalist) reassigns their Medicare billing to Genesis Medical Practice, PLLC. 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. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

What insurance does Genesis Medical Practice, PLLC accept?

Health plans from Blue Cross and Blue Shield of NC list Genesis Medical Practice, PLLC 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 Medical Practice, PLLC was last updated on September 10, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 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.