NPIMap

Individual provider Active NPI

Larry B Roark, NP-C

  • Family Nurse Practitioner
  • Middlesboro, KY
National Provider Identifier
1437281649
Registry record updated Jun 10, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
3005024 Issued in KY
Practice address
2317 Cumberland Ave
Middlesboro, KY 40965-2834
Phone
(606) 242-3100
Fax
(606) 242-3984
NPI assigned
Mar 12, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 10, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 3005024 KY
Family Nurse Practitioner 363LF0000X 3005024 KY Primary

Addresses

Primary practice location

2317 Cumberland Ave
Middlesboro, KY 40965-2834

Mailing address

2317 Cumberland Ave
Middlesboro, KY 40965-2834
Phone (606) 242-3100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KY
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
I20070831000321 KY Practitioner - Nurse Practitioner 6800989195 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Tristate Medical Clinic IncGroup PAC ID 5890713424, 3 clinicians

Practice addresses (Care Compare)

2317 Cumberland Ave
Middlesboro, KY 40965-2834

3503 Cumberland Ave
Middlesboro, KY 40965-2611
Phone (859) 582-7663

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
3005024KYMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Tri-State Familycare, Inc Family Current Accepting new patients
Williamson Emergency Physicians LLC Nurse Practitioner Past Accepting new patients
Emergency Coverage Services, PC Nurse Practitioner Past Accepting new patients

Locations

2317 Cumberland Ave
Middlesboro, KY 40965
Phone (606) 242-3100

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Tri-State Family Health CareMiddlesboro, KY, CCN B03811 Rural health clinic 5% Or Greater Direct Ownership Interest (100%)
Corporate Officer
Corporate Director
W-2 Managing Employee		 May 1, 2017
May 11, 2017
May 11, 2017
May 1, 2017

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

  • Tri State Medical Clinic Inc

    dba Tri-State Family Healthcare

    • Rural Health Clinic/Center
    • Middlesboro, KY
    • NPI 1649370719

    5% Or Greater Direct Ownership Interest, Corporate Director, Corporate Officer, W-2 Managing Employee

    CMS ownership

Organizations & group practices 4

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 4

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": "1173657600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717977600000",
    "number": "1437281649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2317 CUMBERLAND AVE",
            "city": "MIDDLESBORO",
            "state": "KY",
            "postal_code": "409652834",
            "telephone_number": "606-242-3100",
            "fax_number": "606-242-3984"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2317 CUMBERLAND AVE",
            "city": "MIDDLESBORO",
            "state": "KY",
            "postal_code": "409652834",
            "telephone_number": "606-242-3100",
            "fax_number": "606-242-3984"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROARK",
        "first_name": "LARRY",
        "middle_name": "B",
        "credential": "NP-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-12",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "KY",
            "license": "3005024",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "KY",
            "license": "3005024",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Middlesboro, KY

Sources for this page

Verify at the official NPI Registry.