Jennifer Ellen Larson – Internal Medicine Physician

Key facts

NPI: 1306903885
Entity type: Individual (NPI type 1)
Primary specialty: Internal Medicine Physician 207R00000X
License: 2006-00564 (NC)
Practice address: 125 Hospital Dr
Spruce Pine, NC 28777-3035
Phone: (828) 765-4201
NPI assigned: Jan 3, 2007
Sex: Female
Sole proprietor: Yes

Organizations & group practices 3

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.

Hospice & Palliative Care of the Blue Ridge Inc Exclusive Provider Organization · Spruce Pine, NC · NPI 1023084399

Medicare reassignment NPD NC
MH Blue Ridge Medical Center, LLLP Rural Health Clinic/Center · Burnsville, NC · NPI 1881161347

NPD (past)
New Vistas-Mountain Laurel, Inc. Mental Health Clinic/Center (Including Community Mental Health Center) · Hendersonville, NC · NPI 1710937396

NPD (past)

Medicare participation

Medicare fee-for-service enrollment: Enrolled in NC
Eligible to order & refer: Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20070312000363	NC	Practitioner - Internal Medicine Practitioner - Geriatric Medicine	5193760833	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Doctor of Medicine

Practice roles

Organization	Status	New patients
Hospice & Palliative Care of the Blue Ridge Inc	Current since Jun 30, 2018	Accepting new patients
New Vistas-Mountain Laurel, Inc.	Past	Accepting new patients
MH Blue Ridge Medical Center, LLLP	Past	Accepting new patients

Locations

236 Hospital Dr
Spruce Pine, NC 28777
Phone (828) 765-5677

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Internal Medicine Physician	207R00000X	2006-00564	NC	Yes

Addresses

Primary practice location

125 Hospital Dr
Spruce Pine, NC 28777-3035

Mailing address

496 Altapass Hwy
Spruce Pine, NC 28777-3011

Other identifiers

Identifier	Type	State	Issuer
014MX	Other	NC	BCBS LABS
07673	Other	NC	BCBS PHYSICIAN
00513	Other	NC	BCBS
235013B	Other	NC	MEDICARE PHYSICIAN
34U011	Other	NC	MEDICARE SWINGBED
0081P	Other	NC	BCBS SWINGBED
2061740	Other	NC	MEDICARE PHYSICIAN
5906586	Medicaid	NC
8907673	Other	NC	MEDICAID PHYSICIAN
1479X	Other	NC	BCBS INDIVIDUAL PROVIDER
235013	Other	NC	MEDICARE PHYSICIAN
3400011	Other	NC	MEDICAID OSCAR
CA1796	Other	NC	RAILROAD MEDICARE

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Feb 10, 2015.

{
    "created_epoch": "1167782400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1423526400000",
    "number": "1306903885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "496 ALTAPASS HWY",
            "city": "SPRUCE PINE",
            "state": "NC",
            "postal_code": "287773011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "125 HOSPITAL DR",
            "city": "SPRUCE PINE",
            "state": "NC",
            "postal_code": "287773035",
            "telephone_number": "828-765-4201"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "JENNIFER",
        "middle_name": "ELLEN",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-03",
        "last_updated": "2015-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NC",
            "license": "2006-00564",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS LABS",
            "identifier": "014MX",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS PHYSICIAN",
            "identifier": "07673",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "00513",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PHYSICIAN",
            "identifier": "235013B",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE SWINGBED",
            "identifier": "34U011",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS SWINGBED",
            "identifier": "0081P",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PHYSICIAN",
            "identifier": "2061740",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5906586",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID PHYSICIAN",
            "identifier": "8907673",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS INDIVIDUAL PROVIDER",
            "identifier": "1479X",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PHYSICIAN",
            "identifier": "235013",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID OSCAR",
            "identifier": "3400011",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "CA1796",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Spruce Pine, NC

All providers in Spruce Pine, NC · Internal Medicine Physician in North Carolina

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 10, 2015. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Order and Referring (CMS).
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.