Active NPI
Christian Lara-Ensslin, PA-C
- Physician Assistant
- Loris, SC
National Provider Identifier
1124766134
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- Practice address
- 3655 Mitchell St
Loris, SC 29569-2827 - Phone
- (843) 716-7000
- NPI assigned
- May 20, 2022
- Last updated
- Aug 6, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | Primary |
Addresses
Primary practice location
3655 Mitchell St
Loris, SC 29569-2827
Mailing address
3655 Mitchell St
Loris, SC 29569-2827
Phone (843) 716-7000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in SC
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- University of South Carolina School of Medicine, 2022
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
6020 Jibe CT
Awendaw, SC 29429-6320
Phone (843) 697-5727
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4465 | SC | MD | Oral and Maxillofacial Surgery (Dentist) |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| SC Wound Solutions LLC | Current | Accepting new patients |
Interoperability endpoints
- claraensslin24492@directmcleodehealth.org
Organizations & group practices 3
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.
-
- Surgery Physician
- Awendaw, SC
- NPI 1639033780
-
- Emergency Medicine Physician
- Myrtle Beach, SC
- NPI 1861430555
-
- Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
- Awendaw, SC
- NPI 1427815984
Hospital & facility affiliations 1
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Loris Community Hospital
- General Acute Care Hospital
- Loris, SC
- NPI 1306123344
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653004800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1691280000000",
"number": "1124766134",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3655 MITCHELL ST",
"city": "LORIS",
"state": "SC",
"postal_code": "295692827",
"telephone_number": "843-716-7000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3655 MITCHELL ST",
"city": "LORIS",
"state": "SC",
"postal_code": "295692827",
"telephone_number": "843-716-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARA-ENSSLIN",
"first_name": "CHRISTIAN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-05-20",
"last_updated": "2023-08-06",
"certification_date": "2023-08-06",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Loris, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.