Lucille E Kanjer-Larson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

01092632A Issued in IN

Practice address

205 N Tillotson Ave
Muncie, IN 47304-3900

Phone

(765) 291-5437

Fax

(765) 284-5387

NPI assigned

Nov 15, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MA, IN2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lucille.kanjerlarson.p1@direct.meridianhs.nextgenshare.com

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.

• Meridian Health Services Corp

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Muncie, IN
  • NPI 1992755490
  Medicare reassignment NPD
• Community Health Connections, Inc.

  • Federally Qualified Health Center (FQHC)
  • Fitchburg, MA
  • NPI 1477580827
  Medicare reassignment NPD
• Meridian Health Services Corp.

  • Federally Qualified Health Center (FQHC)
  • Montpelier, IN
  • NPI 1417838574
  NPD
• Community Health Connections, Inc.

  • Federally Qualified Health Center (FQHC)
  • Gardner, MA
  • NPI 1225742174
  NPD
• Community Health Connections, Inc.

  • Federally Qualified Health Center (FQHC)
  • Fitchburg, MA
  • NPI 1811149586
  NPD
• Meridian Health Services Corp

  • Federally Qualified Health Center (FQHC)
  • Muncie, IN
  • NPI 1629473053

  Pediatrics

  NPD (past)
• Meridian Health Services Corp

  • Federally Qualified Health Center (FQHC)
  • Bluffton, IN
  • NPI 1669003679
  NPD (past)
• Meridian Health Services Corp

  • Federally Qualified Health Center (FQHC)
  • Muncie, IN
  • NPI 1770808362
  NPD (past)
• Meridian Health Services Corp.

  • Federally Qualified Health Center (FQHC)
  • Fort Wayne, IN
  • NPI 1568192458
  NPD (past)
• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

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

{
    "created_epoch": "1132012800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715644800000",
    "number": "1225010358",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 N TILLOTSON AVE",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473043900",
            "telephone_number": "765-291-5437",
            "fax_number": "978-878-8498"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 N TILLOTSON AVE",
            "city": "MUNCIE",
            "state": "IN",
            "postal_code": "473043900",
            "telephone_number": "765-291-5437",
            "fax_number": "765-284-5387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KANJER-LARSON",
        "first_name": "LUCILLE",
        "middle_name": "E",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-15",
        "last_updated": "2024-05-14",
        "certification_date": "2024-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IN",
            "license": "01092632A",
            "primary": true
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MA",
            "license": "161078",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3199738",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jada Marie-Chawama Kakowa
• Alyssa Kalley
• Padmalatha Kambham I, RPT
• Caitlin Mae Kamplain, PA-C
• Woon Kang, DDS
• Misbah Kanwal, MD
• Mary Karberg
• Sai R Karlapudi, MD
• Elena Rose Karras, MD
• Charles Edward Kates II

• Pediatrics Physician in Muncie, IN
• Providers in Muncie, IN by specialty
• Pediatrics Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 14, 2024; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.