Active NPI
Lao Pha
- Driver
- Big Lake, MN
National Provider Identifier
1245639301
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Driver
- License
- 374889
- Practice address
- 171 Lake St N # 102
Big Lake, MN 55309-9254 - Phone
- (651) 774-1166
- NPI assigned
- Aug 14, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Driver | 172A00000X | 374889 | MN | Primary |
Addresses
Primary practice location
171 Lake St N # 102
Big Lake, MN 55309-9254
Mailing address
171 Lake St N # 102
Big Lake, MN 55309-9254
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| A304195200 | Medicaid | MN |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 374889 | MN | MD | Driver |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Apple Ride LLC | Past | Accepting new patients |
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.
-
- Non-emergency Medical Transport (VAN)
- Big Lake, MN
- NPI 1568823730
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407974400000",
"number": "1245639301",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "171 LAKE ST N # 102",
"city": "BIG LAKE",
"state": "MN",
"postal_code": "553099254"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "171 LAKE ST N # 102",
"city": "BIG LAKE",
"state": "MN",
"postal_code": "553099254",
"telephone_number": "651-774-1166"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHA",
"first_name": "LAO",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-08-14",
"last_updated": "2014-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "172A00000X",
"taxonomy_group": "",
"desc": "Driver",
"state": "MN",
"license": "374889",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "A304195200",
"state": "MN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Big Lake, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.