NPIMap

Individual provider Active NPI

Lauri Renee Larson, MD

  • Family Medicine Physician
  • Walla Walla, WA
National Provider Identifier
1477567881
Registry record updated Jun 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD00043652 Issued in WA
Practice address
380 Chase Ave
Family Practice
Walla Walla, WA 99362-2924
Phone
(509) 522-5822
Fax
(509) 522-5575
NPI assigned
Jul 28, 2006
Last updated
Jun 16, 2021By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 16, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD00043652 WA Primary

Addresses

Primary practice location

380 Chase Ave
Family Practice
Walla Walla, WA 99362-2924

Mailing address

PO Box 34439
Seattle, WA 98124-1439

Other practice location 1

1111 S 2nd Ave
Walla Walla, WA 99362-4118
Phone (509) 897-3700

Other identifiers 2

IdentifierTypeStateIssuer
1477567881MedicaidWA
233127MedicaidOR

Other names 1

  • Lauri Renee Marsh Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address llarson186061@wm.providencedirect.org Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20040803000166 WA Practitioner - Family PracticePractitioner - Obstetrics/Gynecology 0042281263 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family PracticeAlso: Obstetrics/Gynecology
Education
Loma Linda University School of Medicine, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices

Practice addresses (Care Compare)

1025 S 2ND Ave
Walla Walla, WA 99362-4116
Phone (509) 897-3000

380 Chase Ave
Walla Walla, WA 99362-2924
Phone (509) 897-3333

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Melanoma (skin cancer) excision1-10
Removal of skin lesions17
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
Providence Health & Services - Washington Family Medicine CurrentSince Jan 1, 2009 Accepting new patients
Providence Health & Services - Washington Past Accepting new patients
Providence Health & Services - Washington Past Accepting new patients

Locations

1111 S 2nd Ave
Walla Walla, WA 99362
Phone (509) 522-0100

380 Chase Ave
Walla Walla, WA 99362
Phone (509) 526-3333

Interoperability endpoints

  • Direct secure messaging: llarson186061@wm.providencedirect.org

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

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": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1623801600000",
    "number": "1477567881",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 34439",
            "city": "SEATTLE",
            "state": "WA",
            "postal_code": "981241439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "380 CHASE AVE",
            "address_2": "FAMILY PRACTICE",
            "city": "WALLA WALLA",
            "state": "WA",
            "postal_code": "993622924",
            "telephone_number": "509-522-5822",
            "fax_number": "509-522-5575"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1111 S 2nd Ave",
            "address_purpose": "LOCATION",
            "city": "Walla Walla",
            "state": "WA",
            "postal_code": "993624118",
            "country_code": "US",
            "telephone_number": "509-897-3700",
            "fax_number": "509-897-5575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LARSON",
        "first_name": "LAURI",
        "middle_name": "RENEE",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-28",
        "last_updated": "2021-06-16",
        "certification_date": "2021-06-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WA",
            "license": "MD00043652",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1477567881",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "233127",
            "state": "OR"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "llarson186061@wm.providencedirect.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "1111 S 2nd Ave",
            "city": "Walla Walla",
            "state": "WA",
            "country_code": "US",
            "postal_code": "993624118",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "LAURI",
            "last_name": "MARSH",
            "middle_name": "RENEE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Walla Walla, WA

Sources for this page

Verify at the official NPI Registry.