Larry Todd Wilson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA-9110091 Issued in FL

Practice address

2600 Westhall LN
Maitland, FL 32751-7102

Phone

(407) 200-2300

Fax

(407) 303-0580

NPI assigned

May 1, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: lwilson2078876@adventhealth.direct-ci.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.

• Dwic of Tampa Bay, Inc

  • Urgent Care Clinic/Center
  • Hudson, FL
  • NPI 1598132490
  NPD (past)
• Community Health Association

  • Physical Therapy Clinic/Center
  • Ravenswood, WV
  • NPI 1124369780
  NPD (past)
• Community Health Association

  • Rural Health Clinic/Center
  • Ripley, WV
  • NPI 1871606517
  NPD (past)
• Emergency Medicine Physicians of Kanawha County, PLLC

  • Emergency Medicine Physician
  • South Charleston, WV
  • NPI 1326087289
  NPD (past)
• Geoffrey R. Cousins, MD, PLLC

  • Specialist
  • Charleston, WV
  • NPI 1093988545
  NPD (past)
• Nestor F Dans MD PLLC

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Charleston, WV
  • NPI 1386734051
  NPD (past)

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

{
    "created_epoch": "1146441600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696982400000",
    "number": "1245297340",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2600 WESTHALL LN",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517102",
            "telephone_number": "407-200-2300",
            "fax_number": "407-303-0580"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2600 WESTHALL LN",
            "city": "MAITLAND",
            "state": "FL",
            "postal_code": "327517102",
            "telephone_number": "407-200-2300",
            "fax_number": "407-303-0580"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "LARRY",
        "middle_name": "TODD",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-01",
        "last_updated": "2023-10-11",
        "certification_date": "2023-10-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA-9110091",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Willow Path ABA & Learning LC
• Robert Allan Willson, O.D.
• Aliesha Djanea Wilson-Skeete
• Akiva L Wilson
• Bridgette Wilson
• Mikayla Wilson
• Shaynia Renea Wilson
• Vance Edward Wilson, C.R.N.A.
• Tara Winn, MSW
• Winter Park Complementary Medicine

• Physician Assistant in Maitland, FL
• Providers in Maitland, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.