Individual provider Active NPI

Peyton Larus

  • Physician Assistant
  • Myrtle Beach, SC
National Provider Identifier
1265076400
Registry record updated Nov 22, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
4104 Issued in SC
Practice address
920 Doug White Dr Ste 210
Myrtle Beach, SC 29572-4181
Phone
(843) 497-6348
Fax
(843) 497-6351
NPI assigned
Oct 31, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 22, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Physician Assistant 363A00000X 4104 SC Primary

Addresses

Primary practice location

920 Doug White Dr Ste 210
Myrtle Beach, SC 29572-4181

Mailing address

920 Doug White Dr Ste 210
Myrtle Beach, SC 29572-4181
Phone (843) 497-6348

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC, VA2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20211116001955 SC Practitioner - Physician Assistant 7214326057 Reassigns benefits to 1 organization
I20251106003896 VA Practitioner - Physician Assistant 7214326057 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Urgent Specialty Associates PLLCGroup PAC ID 7618235995, 56 clinicians

Practice addresses (Care Compare)

7101 Jahnke Rd
Richmond, VA 23225-4017
Phone (804) 483-0000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Urgent Specialty Associates PLLC CurrentSince Sep 1, 2025 Accepting new patients

Locations

7101 Jahnke Rd
Richmond, VA 23225
Phone (804) 323-1088

Interoperability endpoints

  • Direct secure messaging: peyton.larus@hca5.eclinicaldirectplus.com

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 and National Provider Directory roles.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1572480000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637539200000",
    "number": "1265076400",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 DOUG WHITE DR STE 210",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724181",
            "telephone_number": "843-497-6348",
            "fax_number": "843-497-6351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "920 DOUG WHITE DR STE 210",
            "city": "MYRTLE BEACH",
            "state": "SC",
            "postal_code": "295724181",
            "telephone_number": "843-497-6348",
            "fax_number": "843-497-6351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARUS",
        "first_name": "PEYTON",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-10-31",
        "last_updated": "2021-11-22",
        "certification_date": "2021-11-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "4104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Myrtle Beach, SC

Sources for this page

Verify at the official NPI Registry.