Individual provider Active NPI

Larry Paskar, MD

  • Diagnostic Radiology Physician
  • Bridgeton, MO
National Provider Identifier
1447299334
Registry record updated Aug 30, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
R6344 Issued in MO
Practice address
12303 De Paul Dr
Depaul Health Center
Bridgeton, MO 63044-2512
Phone
(314) 344-6350
NPI assigned
Jun 6, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 30, 2010

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X R6344 MO Primary

Addresses

Primary practice location

12303 De Paul Dr
Depaul Health Center
Bridgeton, MO 63044-2512

Mailing address

502 Earth City PLZ
Suite 121
Earth City, MO 63045-1340
Phone (314) 770-2133

Other identifiers 1

IdentifierTypeStateIssuer
201778800MedicaidMO

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)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
R6344MOMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vascular Institute at Depaul Past Accepting new patients
Ernst Radiology Clinic, Inc Diagnostic Radiology 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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1149552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1283126400000",
    "number": "1447299334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "502 EARTH CITY PLZ",
            "address_2": "SUITE 121",
            "city": "EARTH CITY",
            "state": "MO",
            "postal_code": "630451340",
            "telephone_number": "314-770-2133",
            "fax_number": "314-770-2154"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12303 DE PAUL DR",
            "address_2": "DEPAUL HEALTH CENTER",
            "city": "BRIDGETON",
            "state": "MO",
            "postal_code": "630442512",
            "telephone_number": "314-344-6350"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PASKAR",
        "first_name": "LARRY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-06",
        "last_updated": "2010-08-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "R6344",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201778800",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bridgeton, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.