Individual provider Active NPI

Larry F Widmer, DC

  • Chiropractor
  • Lancaster, PA
National Provider Identifier
1225025463
Registry record updated Dec 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
DC001742L Issued in PA
Practice address
1516 Lititz Pike
Lancaster, PA 17601-6506
Phone
(717) 397-5810
Fax
(717) 397-0276
NPI assigned
Oct 3, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 28, 2011

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 1406 NM
Chiropractor 111N00000X 4829 AZ
Chiropractor 111N00000X DC001742L PA Primary

Addresses

Primary practice location

1516 Lititz Pike
Lancaster, PA 17601-6506

Mailing address

1516 Lititz Pike
Lancaster, PA 17601-6506
Phone (717) 397-5810

Other identifiers 1

IdentifierTypeStateIssuer
0006314300001MedicaidPA

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150320001807 NM Practitioner - Chiropractic 5698839090 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Palmer College Chiropractic - West Sunnyvale, 1977
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1892 Plaza del Sur Dr a
Santa Fe, NM 87505-6073
Phone (505) 988-8017

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
4829AZMDChiropractor
1406NMMDChiropractor

Practice roles

OrganizationSpecialtyStatusNew patients
Larry F Widmer DC LLC CurrentSince Mar 8, 2015 Accepting new patients

Locations

1892 Plaza del Sur Dr
Ste A
Santa Fe, NM 87505
Phone (505) 984-0934

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1128297600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1325030400000",
    "number": "1225025463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1516 LITITZ PIKE",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176016506",
            "telephone_number": "717-397-5810",
            "fax_number": "717-397-0276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1516 LITITZ PIKE",
            "city": "LANCASTER",
            "state": "PA",
            "postal_code": "176016506",
            "telephone_number": "717-397-5810",
            "fax_number": "717-397-0276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDMER",
        "first_name": "LARRY",
        "middle_name": "F",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-03",
        "last_updated": "2011-12-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NM",
            "license": "1406",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AZ",
            "license": "4829",
            "primary": false
        },
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "PA",
            "license": "DC001742L",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0006314300001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lancaster, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 28, 2011; 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.