NPIMap

Individual provider Active NPI

Larissa Forde Dreyer, PA

  • Physician Assistant
  • Lebanon, NH
National Provider Identifier
1194045377
Registry record updated May 23, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
1166 Issued in NH
Practice address
1 Medical Center Dr
Dartmouth Hitchcock - Family Med
Lebanon, NH 03756-1000
Phone
(603) 650-5922
NPI assigned
Jun 10, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 23, 2016

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X 1076-39 WI
Physician Assistant 363A00000X 1166 NH Primary

Addresses

Primary practice location

1 Medical Center Dr
Dartmouth Hitchcock - Family Med
Lebanon, NH 03756-1000

Mailing address

1 Medical Center Dr
Dartmouth Hitchcock - Family Med
Lebanon, NH 03756-1000
Phone (603) 650-5922

Other identifiers 1

IdentifierTypeStateIssuer
1076-39OtherWIWISCONSIN DEPARTMENT OF REGULATION & LICENSING

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160707002213 NH Practitioner - Physician Assistant 2365734522 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Alice Peck Day Memorial HospitalGroup PAC ID 6103737531, 132 clinicians

Practice addresses (Care Compare)

10 Alice Peck Day Dr
Lebanon, NH 03766-2900
Phone (603) 448-3121

5 Alice Peck Day Dr
Lebanon, NH 03766-2901
Phone (603) 448-3122

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
79.66 of 100Reported as apm
Quality
53.51
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
1166NHMDAddiction (Substance Use Disorder) Counselor
1076-39WIMDSpecialist

Practice roles

OrganizationSpecialtyStatusNew patients
Alice Peck Day Memorial Hospital Current Accepting new patients
Dartmouth-Hitchcock Clinic CurrentSince May 4, 2016 Accepting new patients
Alice Peck Day Memorial Hospital CurrentSince Sep 17, 2018 Accepting new patients
Dartmouth-Hitchcock Clinic CurrentSince May 4, 2016 Accepting new patients
Alice Peck Day Memorial Hospital CurrentSince Jan 1, 2026 Accepting new patients
Mary Hitchcock Memorial Hospital CurrentSince May 4, 2016 Accepting new patients

Locations

1 Medical Dr
Lebanon, NH 03756
Phone (603) 650-5922

5 Alice Peck Day Dr
Lebanon, NH 03766
Phone (603) 448-3996

10 Alice Peck Day Dr
Lebanon, NH 03766
Phone (603) 448-7440

Interoperability endpoints

  • FHIR API: https://edhwebportal.hitchcock.org/FHIRProxy/api/FHIR/R4/
  • Direct secure messaging: ldreyer172977@direct.dartmouth-hitchcock.org

Organizations & group practices 7

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 9

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": "1276128000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1463961600000",
    "number": "1194045377",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DR",
            "address_2": "DARTMOUTH HITCHCOCK - FAMILY MED",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037561000",
            "telephone_number": "603-650-5922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER DR",
            "address_2": "DARTMOUTH HITCHCOCK - FAMILY MED",
            "city": "LEBANON",
            "state": "NH",
            "postal_code": "037561000",
            "telephone_number": "603-650-5922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DREYER",
        "first_name": "LARISSA",
        "middle_name": "FORDE",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-06-10",
        "last_updated": "2016-05-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "WI",
            "license": "1076-39",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NH",
            "license": "1166",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WISCONSIN DEPARTMENT OF REGULATION & LICENSING",
            "identifier": "1076-39",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lebanon, NH

Sources for this page

Verify at the official NPI Registry.