Active NPI
Nathan Larson, PSY.D,, HSPP
- Clinical Psychologist
- Indianapolis, IN
National Provider Identifier
1306028295
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 20042106A
- Practice address
- 9106 N Meridian St
Suite 100
Indianapolis, IN 46260-1884 - Phone
- (317) 575-9111
- Fax
- (317) 571-4470
- NPI assigned
- Dec 3, 2007
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 20042106A | IN | Primary |
Addresses
Primary practice location
9106 N Meridian St
Suite 100
Indianapolis, IN 46260-1884
Mailing address
9106 N Meridian St
Suite 100
Indianapolis, IN 46260-1884
Phone (317) 575-9111
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200888350 | Medicaid | IN |
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 |
|---|---|---|---|
| 20042106A | IN | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Childrens Resource Group | Clinical | Past | Accepting new patients |
| Children'S Resource Group | Past | Accepting new patients |
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.
-
- Child & Adolescent Psychiatry Physician
- Indianapolis, IN
- NPI 1528107927
-
- Clinical Psychologist
- Indianapolis, IN
- NPI 1801035589
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1196640000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1316995200000",
"number": "1306028295",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9106 N MERIDIAN ST",
"address_2": "SUITE 100",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462601884",
"telephone_number": "317-575-9111",
"fax_number": "317-571-4470"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9106 N MERIDIAN ST",
"address_2": "SUITE 100",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462601884",
"telephone_number": "317-575-9111",
"fax_number": "317-571-4470"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "NATHAN",
"name_prefix": "Dr.",
"credential": "PSY.D,, HSPP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-12-03",
"last_updated": "2011-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "IN",
"license": "20042106A",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "200888350",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.