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GENESIS FAMILY PRACTICE LLC
NPI 1447799242
General Practice in Ormond Beach, FL

Active since February 14, 2017CLIA 10D2137312 · Waiver
800 S NOVA RD, SUITE I, ORMOND BEACH, FL 32174(386) 676-9300(386) 676-9050 Get Directions Write a Review

NPPES record last updated: November 28, 2022. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Nov 28, 2022, Apr 17, 2018, Mar 16, 2017 and 1 more (4 updates tracked since 2017).

About Genesis Family Practice Llc NPPES

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

GENESIS FAMILY PRACTICE LLC (NPI 1447799242) is a healthcare organization registered as a general practice in Ormond Beach, Florida and active in the NPI registry since February 2017. The organization holds a CLIA Waiver certificate valid through July 13, 2028 and lists Jay C Chanmugam, Owner, as its authorized official.

NPPES Registry Identity

NPI1447799242
Entity TypeOrganization
Primary Taxonomy208D00000X
Legal Business NameGENESIS FAMILY PRACTICE LLC
Location Address800 S NOVA RD, SUITE IOrmond Beach, FL 32174-9048
Mailing Address1133 Saxon Blvd, Ste 200Orange City, FL 32763-8425 · (386) 218-2353 · Fax (386) 228-9701
Phone(386) 676-9300
Fax(386) 676-9050
Organization SubpartNo
Authorized OfficialJay C ChanmugamOwner · (386) 218-2353
Enumeration DateFebruary 14, 2017
Last NPPES UpdateNovember 28, 20224 updates tracked since enumeration
NPPES CertifiedNovember 28, 2022
✔ NPI 1447799242 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyGeneral PracticeAllopathic & Osteopathic Physicians
Taxonomy Code208D00000X
License✔ Licensed in FL · OS8600
Definition
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions. Source: National Uniform Claim Committee
800 S NOVA RD, Ormond Beach, FL 32174
Open in Google Maps ↗

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Florida Blue (BlueCross BlueShield FL).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

6

Medicare 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 within 10 miles. They are listed nearest first.

Clinicians, nearest first (6)

Aixsa Perez, M.D.
General Practice
NPI 1639171853
1425 DUNN AVE
Daytona Beach, FL 32114
(386) 323-9600
✔ PECOS✔ Accepts Medicare3.8 mi
April Gustafson, APRN
Nurse Practitioner
NPI 1811473275
557 ADENMORE TER
Deland, FL 32724
(910) 578-4755
✔ PECOS✔ Accepts Medicare23 mi
Jay Chanmugam, DO
General Practice
NPI 1518905207
1133 SAXON BLVD
Orange City, FL 32763
(386) 228-9700
✔ PECOS✔ Accepts Medicare27 mi
Cameka Campbell
Nurse Practitioner
NPI 1043753437
187 SABAL PALM DR STE 100
Longwood, FL 32779
(407) 353-1336
✔ PECOS43 mi
Cesar Corretjer Russi, M.D.
General Practice
NPI 1164619367
1580 SANTA BARBARA BLVD
The Villages, FL 32159
(352) 259-2159
✔ PECOS58 mi
Sylvia Collazo, MD
Family Practice
NPI 1063435592
833 E OAK ST
Kissimmee, FL 34744
(407) 350-3373
✔ PECOS69 mi

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 10D2137312

Genesis Family Practice LLC · Ormond Beach, FL
Active · expires Jul 13, 2028
CLIA Number10D2137312
Laboratory TypePhysician Office
Certificate Effective DateJuly 14, 2026
Certificate Expiration DateJuly 13, 2028
Laboratory DirectorJay Chanmugam
Laboratory Phone(386) 676-9300
Laboratory LocationGenesis Family Practice LLC800 S Nova Rd, Ormond Beach, FL 32174
CLIA data matches this NPI record on: Address Name Phone
This certificate is issued to a laboratory to perform only waived tests.

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 1447799242. It was assigned to this organization in the NPPES registry on February 14, 2017.

Where is Genesis Family Practice LLC located?

Genesis Family Practice LLC is located at 800 S Nova Rd Suite I, Ormond Beach, FL 32174. The listed phone number is (386) 676-9300.

What is Genesis Family Practice LLC's specialty?

The primary specialty registered for this NPI is General Practice with taxonomy code 208D00000X.

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 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 10D2137312) is associated with this NPI, valid through July 13, 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.