NPIMap

Individual provider Active NPI

Travis L Larson, M.D.

  • Family Medicine Physician
  • Milton, FL
National Provider Identifier
1417482373
Registry record updated Jun 30, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
ME144531 Issued in FL
Practice address
5907 Berryhill Rd
Milton, FL 32570-8278
Phone
(850) 623-9787
NPI assigned
Apr 27, 2017
Last updated
Jun 30, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 30, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X ME144531 FL Primary

Addresses

Primary practice location

5907 Berryhill Rd
Milton, FL 32570-8278

Mailing address

5907 Berryhill Rd
Milton, FL 32570-8278
Phone (850) 623-9787

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200616000887 FL Practitioner - Family Practice 5597038190 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gulf Coast Physician PartnersGroup PAC ID 5597751776, 5 clinicians

Practice addresses (Care Compare)

5907 Berryhill Rd
Milton, FL 32570-8278
Phone (850) 623-9787

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions32
Removal of nail tissue1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Gulf Coast Physician Partners Current Accepting new patients
Gulf Coast Physician Partners Family Medicine CurrentSince Aug 1, 2020 Accepting new patients

Locations

5907 Berryhill Rd
Milton, FL 32570
Phone (850) 437-8711

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 10

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": "1493251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593475200000",
    "number": "1417482373",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5907 BERRYHILL RD",
            "city": "MILTON",
            "state": "FL",
            "postal_code": "325708278",
            "telephone_number": "850-623-9787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5907 BERRYHILL RD",
            "city": "MILTON",
            "state": "FL",
            "postal_code": "325708278",
            "telephone_number": "850-623-9787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "TRAVIS",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-27",
        "last_updated": "2020-06-30",
        "certification_date": "2020-06-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME144531",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milton, FL

Sources for this page

Verify at the official NPI Registry.