| Genesis Eldercare Physician Services Llc | |
|
464 Main St Heritage Hall East Agawam MA 01001 | |
| (413) 786-8000 | |
| (413) 789-1099 |
| Full Name | Genesis Eldercare Physician Services Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 464 Main St, Agawam, Massachusetts |
| Authorized Official Name and Position | Eric Shapiro (VP, CONTROLLER) |
| Authorized Official Contact | 4108327790 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Genesis Eldercare Physician Services Llc Po Box 62946 Baltimore MD 21264-2946 Ph: (410) 494-7607 | Genesis Eldercare Physician Services Llc 464 Main St Heritage Hall East Agawam MA 01001 Ph: (413) 786-8000 |
| NPI Number | 1104819259 |
|---|---|
| Provider Enumeration Date | 08/24/2005 |
| Last Update Date | 08/05/2019 |
| Medicare PECOS PAC ID | 9830002534 |
|---|---|
| Medicare Enrollment ID | O20040824000702 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104819259 | NPI | - | NPPES |
| 9770917 | Medicaid | MA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | 75866 (Massachusetts) | Primary |
| Provider Name | Vivienne Yumasi |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528242203 PECOS PAC ID: 6406938703 Enrollment ID: I20080125000175 |
| Provider Name | Julius Tanyi V Tabe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1801093356 PECOS PAC ID: 8729104963 Enrollment ID: I20100925000052 |
| Provider Name | Julie Mcgondel |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1487924445 PECOS PAC ID: 4789847369 Enrollment ID: I20120517000453 |
| Provider Name | Jatinder Aujla |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275700825 PECOS PAC ID: 7214000207 Enrollment ID: I20121226000197 |
| Provider Name | Nelson K Aweh |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891923199 PECOS PAC ID: 0749423507 Enrollment ID: I20130826000835 |
| Provider Name | Amanda Hernandez |
|---|---|
| Provider Type | Practitioner - Geriatric Medicine |
| Provider Identifiers | NPI Number: 1891062691 PECOS PAC ID: 4880847102 Enrollment ID: I20130910000234 |
| Provider Name | Peterson Remy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1972059665 PECOS PAC ID: 1052682515 Enrollment ID: I20170802002510 |
Am Medical Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 723 Main St, Agawam, MA 01001 Phone: 413-374-0031 Fax: 413-384-2526 | |
Internal Medicine Pc Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 377 Walnut Street Extension, Agawam, MA 01001 Phone: 413-786-7217 Fax: 413-786-7219 | |
Geriatric Primary Care Pc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 723 Main St, Agawam, MA 01001 Phone: 413-374-0031 Fax: 413-384-2526 |