Active NPI
Andrea Larsen
- Physician Assistant
- Buffalo, NY
National Provider Identifier
1578050068
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 022121
- Practice address
- 100 College Pkwy
Buffalo, NY 14221-6800 - Phone
- (716) 626-0093
- NPI assigned
- Apr 19, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 022121 | NY | Primary |
Addresses
Primary practice location
100 College Pkwy
Buffalo, NY 14221-6800
Mailing address
4360 Rushford Dr
Hamburg, NY 14075-3081
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2018
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
100 College Pkwy
Suite 100
Williamsville, NY 14221-6800
Phone (716) 626-0093
1014 Delaware Ave
Buffalo, NY 14209-1606
Phone (207) 518-8869
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 022121 | NY | MD | Physician Assistant |
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.
-
- Physical Medicine & Rehabilitation Physician
- Williamsville, NY
- NPI 1326394701
-
- Physical Medicine & Rehabilitation Physician
- Portland, ME
- NPI 1629430087
NY
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1524096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636329600000",
"number": "1578050068",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4360 RUSHFORD DR",
"city": "HAMBURG",
"state": "NY",
"postal_code": "140753081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 COLLEGE PKWY",
"city": "BUFFALO",
"state": "NY",
"postal_code": "142216800",
"telephone_number": "716-626-0093"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSEN",
"first_name": "ANDREA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-04-19",
"last_updated": "2021-11-08",
"certification_date": "2021-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NY",
"license": "022121",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Buffalo, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2021; 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.