Individual provider Active NPI

Paul Clay Larson, M.D.

  • Diagnostic Radiology Physician
  • Alexandria, LA
National Provider Identifier
1093713323
Registry record updated May 9, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
015700 Issued in LA
Practice address
3704 North Blvd
Suite 1
Alexandria, LA 71301-3606
Phone
(318) 442-8399
Fax
(318) 448-9897
NPI assigned
Jul 11, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 9, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 015700 LA
Diagnostic Radiology Physician 2085R0202X 015700 LA Primary

Addresses

Primary practice location

3704 North Blvd
Suite 1
Alexandria, LA 71301-3606

Mailing address

3704 North Blvd
Suite 1
Alexandria, LA 71301-3606
Phone (318) 442-8399

Other identifiers 2

IdentifierTypeStateIssuer
300083622OtherLARAILROAD MEDICARE
1321699MedicaidLA

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)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
015700LAMDSpecialist
15700LAMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Second Avenue MRI LLC Diagnostic Radiology PastSince Jul 19, 2014 Accepting new patients
Central Louisiana Imaging, Inc. Specialist Past Accepting new patients
Minimally Invasive Image Guided Specialists, LLC Specialist Past Accepting new patients
Central Louisiana Imaging Center LLC PastSince Nov 16, 2004 Accepting new patients
Christus Health Central Louisiana Past Accepting new patients
Cenla Images Associates Specialist Past Accepting new patients

Organizations & group practices 6

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

NPI Registry JSON

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

{
    "created_epoch": "1121040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304899200000",
    "number": "1093713323",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3704 NORTH BLVD",
            "address_2": "SUITE 1",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713013606",
            "telephone_number": "318-442-8399",
            "fax_number": "318-448-9897"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3704 NORTH BLVD",
            "address_2": "SUITE 1",
            "city": "ALEXANDRIA",
            "state": "LA",
            "postal_code": "713013606",
            "telephone_number": "318-442-8399",
            "fax_number": "318-448-9897"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "PAUL",
        "middle_name": "CLAY",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-07-11",
        "last_updated": "2011-05-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "LA",
            "license": "015700",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "LA",
            "license": "015700",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "300083622",
            "state": "LA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1321699",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Alexandria, LA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2011; 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.