Larissa Kyle Bishop, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

2901018015 Issued in MI

Practice address

3181 Prairie St SW
Suite 106
Grandville, MI 49418-2097

Phone

(616) 531-0360

Fax

(616) 531-2810

NPI assigned

Jul 19, 2006

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275552010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "813 CHIPPEWA DR SE",
            "city": "GRAND RAPIDS",
            "state": "MI",
            "postal_code": "495063319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3181 PRAIRIE ST SW",
            "address_2": "SUITE 106",
            "city": "GRANDVILLE",
            "state": "MI",
            "postal_code": "494182097",
            "telephone_number": "616-531-0360",
            "fax_number": "616-531-2810"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BISHOP",
        "first_name": "LARISSA",
        "middle_name": "KYLE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MI",
            "license": "2901018015",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "4487030",
            "state": "MI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "D180150",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michelle Lynn Beyer, COTAL
• Beyond Clean Home Help Care
• Courtney Biehl, PHARM D
• Abraham Bilyeu, PHD
• Joshua Bishop, PHD, LMSW
• Michele Grace Bishop
• Lauren Zedan Blenman, D.O
• Blue Bridge ABA PLLC
• Mary Elizabeth Boekhoven
• Jane Elizabeth Boeschenstein, D.D.S.

• All providers in Grandville, MI
• General Practice Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.