NPIMap

Individual provider Active NPI

Larry J Marshall, MD

  • Family Medicine Physician
  • Lakeside, CA
National Provider Identifier
1114018132
Registry record updated Dec 16, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A52344 Issued in CA
Practice address
12517 Lakeshore Dr
Lakeside, CA 92040-3103
Phone
(619) 443-3843
Fax
(619) 390-1810
NPI assigned
Sep 27, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 16, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 16913 NV
Family Medicine Physician 207Q00000X A52344 CA Primary

Addresses

Primary practice location

12517 Lakeshore Dr
Lakeside, CA 92040-3103

Mailing address

12517 Lakeshore Dr
Lakeside, CA 92040-3103
Phone (619) 443-3843

Other practice location 1

170 S Green Valley Pkwy Ste 300
Henderson, NV 89012-3145
Phone (702) 791-1294

Other identifiers 1

IdentifierTypeStateIssuer
00A523440MedicaidCA

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address larrymarshall@marla.allscriptsdirect.net Health Information Exchange (HIE)

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NV2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110504000301 CA Practitioner - Family Practice 2860420486 Reassigns benefits to 2 organizations
I20171003007699 NV Practitioner - Family Practice 2860420486

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

12517 Lakeshore Dr
Lakeside, CA 92040-3103
Phone (619) 443-3843

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
52344CAMDDentist
A52344CAMDFamily Medicine Physician
16913NVMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Larry J Marshall MD a Professional Corporation General Practice CurrentSince Mar 1, 1998 Accepting new patients
Emergency and Acute Care Medical Corporation CurrentSince Oct 21, 2016 Accepting new patients
Grossmont Hospital Corporation Past Accepting new patients
Dignity Health Past Accepting new patients

Locations

12517 Lakeshore Dr
Lakeside, CA 92040
Phone (619) 443-3843

7901 Frost St
San Diego, CA 92123
Phone (619) 541-3400

Interoperability endpoints

  • Direct secure messaging: larry_marshall@yourcarecommunity.org
  • Direct secure messaging: lmarshall33590@sharphealthcare.direct-ci.com

Organizations & group practices 4

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.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1159315200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608076800000",
    "number": "1114018132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12517 LAKESHORE DR",
            "city": "LAKESIDE",
            "state": "CA",
            "postal_code": "920403103",
            "telephone_number": "619-443-3843",
            "fax_number": "619-390-1810"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12517 LAKESHORE DR",
            "city": "LAKESIDE",
            "state": "CA",
            "postal_code": "920403103",
            "telephone_number": "619-443-3843",
            "fax_number": "619-390-1810"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "170 S Green Valley Pkwy Ste 300",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "NV",
            "postal_code": "890123145",
            "country_code": "US",
            "telephone_number": "702-791-1294",
            "fax_number": "702-850-2820",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MARSHALL",
        "first_name": "LARRY",
        "middle_name": "J",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-27",
        "last_updated": "2020-12-16",
        "certification_date": "2020-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NV",
            "license": "16913",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A52344",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00A523440",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "larrymarshall@marla.allscriptsdirect.net",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "12517 Lakeshore Dr",
            "city": "Lakeside",
            "state": "CA",
            "country_code": "US",
            "postal_code": "920403103",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Lakeside, CA

Sources for this page

Verify at the official NPI Registry.