Larry L Fontanilla Jr., MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

MD00043682 Issued in WA

Practice address

413 Lilly Rd NE
Olympia, WA 98506-5133

Phone

(360) 491-9480

NPI assigned

Jun 9, 2006

Last updated

Nov 27, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 6

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Emergency Medicine

Education

University of Hawaii John a. Burns School of Medicine, 1999

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Olympia Emergency Services PLLCGroup PAC ID 9335035633, 31 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Providence St Peter Hospital Hospital, Olympia, WA, CCN 500024

Merit-based Incentive Payment System (MIPS)

Final score

93.33 of 100Reported as group

Quality

87.43

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• Olympia Emergency Services, PLLC

  • Emergency Medicine Physician
  • Olympia, WA
  • NPI 1346267796
  Medicare reassignment Care Compare group NPD
• Doctors for Emergency Service

  • Emergency Medicine Physician
  • Newark, DE
  • NPI 1750369674
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Providence Health & Services Washington

  dba Providence St Peter Hospital

  • General Acute Care Hospital
  • Olympia, WA
  • NPI 1346250594
  Care Compare affiliation
• Providence Health & Services Washington

  • General Acute Care Hospital
  • Olympia, WA
  • NPI 1619176997
  Care Compare affiliation

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1196121600000",
    "number": "1518908797",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5007",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "985095007",
            "telephone_number": "800-599-0166"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 LILLY RD NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065133",
            "telephone_number": "360-491-9480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONTANILLA",
        "first_name": "LARRY",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2007-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "WA",
            "license": "MD00043682",
            "primary": true
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "WA",
            "license": "MD00043682",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH",
            "identifier": "H39247",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8396830",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA CRIME VICTIMS",
            "identifier": "8939281",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BS",
            "identifier": "2537FO",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00234764",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WA L & I",
            "identifier": "191058",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Arthur Lee Foley III, M.D.
• Vivian L Folsom, MSS
• Meghan Fonken, PA-C
• Jutta Fonseca, MA61091263
• Princewill Fonta, PMHNP
• Ahmad Fora, MD
• Forest Shores Capital (Joshua Grant, PA-C)
• Imanie Marie Forest, RN
• Elizabeth Forman Serdar, ARNP
• Celia G Forno, PMHNP

• Emergency Medicine Physician in Olympia, WA
• Providers in Olympia, WA by specialty
• Emergency Medicine Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.