Individual provider Active NPI

Teresa Lynn Larson, CHIROPRACTOR

  • Chiropractor
  • Lincoln, NE
National Provider Identifier
1295743284
Registry record updated Aug 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
1203 Issued in NE
Practice address
1501 Pine Lake Rd
Ste #2
Lincoln, NE 68512-3692
Phone
(402) 421-8284
Fax
(402) 421-8220
NPI assigned
Aug 4, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 1203 NE Primary

Addresses

Primary practice location

1501 Pine Lake Rd
Ste #2
Lincoln, NE 68512-3692

Mailing address

1501 Pine Lake Rd
Ste #2
Lincoln, NE 68512-3692
Phone (402) 421-8284

Other identifiers 1

IdentifierTypeStateIssuer
09740OtherNEBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NE

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040920000943 NE Practitioner - Chiropractic 3577531656 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Cleveland Chiropractic College - Kansas City, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

1501 Pine Lake Rd
Lincoln, NE 68512-3692
Phone (402) 421-8284

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
1203NEMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Southwest Chiropractic Center PC Chiropractor CurrentSince Aug 1, 2004 Accepting new patients
Madison Chiropractic Clinic PC Chiropractor Past Accepting new patients

Locations

1501 Pine Lake Rd
Ste 2
Lincoln, NE 68512
Phone (402) 421-8284

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.

NPI Registry JSON

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1344988800000",
    "number": "1295743284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1501 PINE LAKE RD",
            "address_2": "STE #2",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685123692",
            "telephone_number": "402-421-8284",
            "fax_number": "402-421-8220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 PINE LAKE RD",
            "address_2": "STE #2",
            "city": "LINCOLN",
            "state": "NE",
            "postal_code": "685123692",
            "telephone_number": "402-421-8284",
            "fax_number": "402-421-8220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "TERESA",
        "middle_name": "LYNN",
        "credential": "CHIROPRACTOR",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-04",
        "last_updated": "2012-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "NE",
            "license": "1203",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "09740",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lincoln, NE

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.