Individual provider Active NPI

Larissa Heron

  • Physical Therapist
  • New York, NY
National Provider Identifier
1205567781
Registry record updated Jun 23, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
P115555 Issued in NY
Practice address
120 W 23Rd St
New York, NY 10011-2473
Phone
(212) 320-9797
NPI assigned
Jun 23, 2022
Last updated
Jun 23, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 23, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X P115555 NY Primary

Addresses

Primary practice location

120 W 23Rd St
New York, NY 10011-2473

Mailing address

120 W 23Rd St
New York, NY 10011-2473

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231013001694 NY Practitioner - Physical Therapist in Private Practice 7113372962 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Optum Medical Care PCGroup PAC ID 9931013240, 1,013 clinicians

Practice addresses (Care Compare)

120 W 23Rd St
New York, NY 10011-2473
Phone (212) 320-9797

Merit-based Incentive Payment System (MIPS)

Final score
82.13 of 100Reported as group
Quality
72.13
Promoting interoperability
91
Improvement activities
40
Cost
75.81

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
P115555NYMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Optum Medical Care, P.C. CurrentSince Aug 29, 2023 Accepting new patients
Optum Medical Care, P.C. CurrentSince Aug 29, 2023 Accepting new patients

Locations

2322 30th Ave
Astoria, NY 11102
Phone (718) 267-2763

110 S Bedford Rd
Mount Kisco, NY 10549
Phone (763) 910-9192

90 S Bedford Rd
Mount Kisco, NY 10549
Phone (914) 242-1050

120 W 23rd St
New York, NY 10011
Phone (212) 320-9797

Philadelphia, PA 19195

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1655942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655942400000",
    "number": "1205567781",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "120 W 23RD ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100112473"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 W 23RD ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100112473",
            "telephone_number": "212-320-9797"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HERON",
        "first_name": "LARISSA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-23",
        "last_updated": "2022-06-23",
        "certification_date": "2022-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "NY",
            "license": "P115555",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.

Verify at the official NPI Registry.