NPIMap

Individual provider Active NPI

Craig M Larsen, CPRC, CPRC-S

  • Peer Specialist
  • Caldwell, ID
National Provider Identifier
1063139772
Registry record updated Oct 24, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Peer SpecialistTaxonomy code 175T00000X
License
11926 Issued in ID
Practice address
304 W Logan St
Caldwell, ID 83605-4735
Phone
(208) 402-6782
NPI assigned
Oct 24, 2022
Last updated
Oct 24, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Peer Specialist 175T00000X 11926 ID Primary

Addresses

Primary practice location

304 W Logan St
Caldwell, ID 83605-4735

Mailing address

304 W Logan St
Caldwell, ID 83605-4735
Phone (208) 402-6782

Electronic endpoints 1

TypeEndpointUseAffiliation
CONNECT URL Clarsen@moonlightmountainrecovery.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
11926IDMDPeer Specialist

Practice roles

OrganizationSpecialtyStatusNew patients
Community Health Clinics, Inc. Peer Specialist Past Accepting new patients
Community Health Clinics, Inc. Past Accepting new patients
Community Health Clinics, Inc. Past Accepting new patients
Community Health Clinics, Inc. Peer Specialist Past Accepting new patients
Community Health Clinics, Inc. Past Accepting new patients
Community Health Clinics, Inc Peer Specialist Past Accepting new patients
Community Health Clinics, Inc. Past Accepting new patients
Community Health Clinics, Inc. Past Accepting new patients
Community Health Clinics, Inc. Peer Specialist Past Accepting new patients
Community Health Clinics, Inc. Past Accepting new patients
Community Health Clinics, Inc. Past Accepting new patients
Community Health Clinics, Inc. Past Accepting new patients
Community Health Clinics, Inc. Past Accepting new patients
Community Health Clinics, Inc. Past Accepting new patients
Community Health Clinics, Inc. Past Accepting new patients
Community Health Clinics, Inc. Past Accepting new patients

Organizations & group practices 16

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.

View all 16

NPI Registry JSON

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

{
    "created_epoch": "1666569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666569600000",
    "number": "1063139772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "304 W LOGAN ST",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836054735",
            "telephone_number": "208-402-6782"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "304 W LOGAN ST",
            "city": "CALDWELL",
            "state": "ID",
            "postal_code": "836054735",
            "telephone_number": "208-402-6782"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "CRAIG",
        "middle_name": "M",
        "credential": "CPRC, CPRC-S",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-10-24",
        "last_updated": "2022-10-24",
        "certification_date": "2022-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "ID",
            "license": "11926",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Clarsen@moonlightmountainrecovery.com",
            "affiliation": "N",
            "address_1": "304 W Logan St",
            "city": "Caldwell",
            "state": "ID",
            "country_code": "US",
            "postal_code": "836054735",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Caldwell, ID

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2022; 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.