Individual provider Active NPI

Ann C Larocca

  • Family Nurse Practitioner
  • Clearlake, CA
National Provider Identifier
1306149240
Registry record updated Feb 8, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
296025 Issued in CA
Practice address
15230 Lakeshore Dr
Clearlake, CA 95422-8107
Phone
(707) 995-4500
NPI assigned
Dec 15, 2010
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 8, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 296025 CA Primary

Addresses

Primary practice location

15230 Lakeshore Dr
Clearlake, CA 95422-8107

Mailing address

15230 Lakeshore Dr
Clearlake, CA 95422-8107
Phone (707) 995-4500

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20200113002412 CA Practitioner - Nurse Practitioner 2365877784 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Adventist Health Clearlake Hospital Inc.Group PAC ID 3072421197, 84 clinicians

Practice addresses (Care Compare)

15630 18TH Ave
Clearlake, CA 95422-9336
Phone (707) 994-6486

Hospital & facility affiliations

  • Adventist Health Home Care Services Home health agency, Lower Lake, CA, CCN 057710
  • Sutter Care at Home Home health agency, Lakeport, CA, CCN 057620
  • Adventist Health Clearlake Hospital, Clearlake, CA, CCN 051317
  • Adventist Health Ukiah Valley Hospital, Ukiah, CA, CCN 050301
  • Sutter Lakeside Hospital Hospital, Lakeport, CA, CCN 051329

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
19901CAMDAcupuncturist

Practice roles

OrganizationSpecialtyStatusNew patients
Adventist Health Clearlake Hospital Inc. CurrentSince Jun 1, 2024 Accepting new patients
Adventist Health Clearlake Hospital, Inc Past Accepting new patients

Locations

15230 Lakeshore Dr
Clearlake, CA 95422
Phone (707) 995-4500

15630 18th Ave
Clearlake, CA 95422
Phone (707) 995-5820

15322 Lakeshore Dr
Ste 102
Clearlake, CA 95422
Phone (707) 994-2030

5290 State St
Kelseyville, CA 95451
Phone (707) 279-8813

19270 Highway 12
Sonoma, CA 95476
Phone (707) 939-6070

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 5

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": "1292371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1486512000000",
    "number": "1306149240",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15230 LAKESHORE DR",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954228107",
            "telephone_number": "707-995-4500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15230 LAKESHORE DR",
            "city": "CLEARLAKE",
            "state": "CA",
            "postal_code": "954228107",
            "telephone_number": "707-995-4500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LAROCCA",
        "first_name": "ANN",
        "middle_name": "C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-12-15",
        "last_updated": "2017-02-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "296025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Clearlake, CA

Sources for this page

Verify at the official NPI Registry.