Provider Demographics
NPI:1871562389
Name:GENARIS, PETER J III (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:J
Last Name:GENARIS
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6675 HOLMES RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64131-1150
Mailing Address - Country:US
Mailing Address - Phone:816-333-5005
Mailing Address - Fax:816-333-6351
Practice Address - Street 1:6675 HOLMES RD
Practice Address - Street 2:SUITE 300
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-1150
Practice Address - Country:US
Practice Address - Phone:816-333-5005
Practice Address - Fax:816-333-6351
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002025A207V00000X
MO2009014176207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000196459OtherANTHEM PROVIDER NUMBER
IN11484484OtherCAQH NUMBER
KS100160600GMedicaid
IN200211960Medicaid
IN9028181OtherPHCS PID NUMBER
IN000000196459OtherANTHEM PROVIDER NUMBER
IN815510QMedicare PIN
IN815500J5Medicare PIN
IN200211960Medicaid
IN224390PPMedicare PIN
IN815460EEMedicare PIN