Lillie Larsen, REGISTERED DIETICIAN

Primary specialty

Registered DietitianTaxonomy code 133V00000X

Practice address

285 Memorial Dr
Crystal Lake, IL 60014-6260

Phone

(815) 356-2383

Fax

(815) 356-2385

NPI assigned

Nov 14, 2006

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Centegra Primary Care, LLC

  dba Centegra Physician Care, LLC

  • Family Medicine Physician
  • Woodstock, IL
  • NPI 1700905205
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1003988130",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13707 W JACKSON ST",
            "city": "WOODSTOCK",
            "state": "IL",
            "postal_code": "600983141",
            "telephone_number": "815-206-1067",
            "fax_number": "815-338-6297"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 MEMORIAL DR",
            "city": "CRYSTAL LAKE",
            "state": "IL",
            "postal_code": "600146260",
            "telephone_number": "815-356-2383",
            "fax_number": "815-356-2385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "LILLIE",
        "credential": "REGISTERED DIETICIAN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-11-14",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sarah Landon
• Jessica Ann Lang, M.S.
• Lantern Therapy Services, LTD
• Amanda S Lareau, M.D.
• Laurie Anne Larsen, PHD, LCPC
• Sharon E. Larsen, DNP - APN
• Rene Las, BCBA
• Nanette Lasco, MSW, LCSW
• Jake Laukert, PT, DPT
• Laura Strong LLC

• Registered Dietitian in Crystal Lake, IL
• Providers in Crystal Lake, IL by specialty
• Registered Dietitian in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.