Individual provider Active NPI

Aimee Susan Larson, RPA-C

  • Physician Assistant
  • Buffalo, NY
National Provider Identifier
1285930974
Registry record updated Jan 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
014597 Issued in NY
Practice address
462 Grider St
Suny CC Building
Buffalo, NY 14215-3021
Phone
(716) 898-5272
NPI assigned
Jan 28, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 28, 2011

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 014597 NY Primary

Addresses

Primary practice location

462 Grider St
Suny CC Building
Buffalo, NY 14215-3021

Mailing address

12 Sweet Briar CT
Tonawanda, NY 14150-7506
Phone (716) 833-3850

Medicare participation

Medicare enrollment files
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.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
014597NYMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Kinkel Neurologic Center, LLP CurrentSince Mar 23, 2017 Accepting new patients

Locations

908 Niagara Falls Blvd
Ste 208
North Tonawanda, NY 14120
Phone (716) 649-1613

5 Limestone Dr
Ste B
Williamsville, NY 14221
Phone (716) 632-9399

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": "1296172800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1296172800000",
    "number": "1285930974",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12 SWEET BRIAR CT",
            "city": "TONAWANDA",
            "state": "NY",
            "postal_code": "141507506",
            "telephone_number": "716-833-3850"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "462 GRIDER ST",
            "address_2": "SUNY CC BUILDING",
            "city": "BUFFALO",
            "state": "NY",
            "postal_code": "142153021",
            "telephone_number": "716-898-5272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "AIMEE",
        "middle_name": "SUSAN",
        "credential": "RPA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-01-28",
        "last_updated": "2011-01-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "014597",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Buffalo, NY

Sources for this page

Verify at the official NPI Registry.