Individual provider Active NPI

Paul Robert Larson, NP

  • Family Nurse Practitioner
  • East Wenatchee, WA
National Provider Identifier
1629134960
Registry record updated Jun 29, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
R1340646 Issued in MN
Practice address
100 Highline Dr
East Wenatchee, WA 98802-5341
Phone
(509) 884-0641
NPI assigned
Dec 29, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 29, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X R1340646 MN Primary

Addresses

Primary practice location

100 Highline Dr
East Wenatchee, WA 98802-5341

Mailing address

820 N Chelan Ave
Wenatchee, WA 98801-2028

Other identifiers 2

IdentifierTypeStateIssuer
1629134960MedicaidWA
316364OtherWAL&I

Electronic endpoints 2

TypeEndpointUseAffiliation
Direct Messaging Address PLARSON18323@EDIRECT.CHEHR.ORG
FHIR URL https://epicproxy.et0764.epichosted.com/FHIRProxy/api/FHIR/R4/

Medicare participation

Medicare enrollment files
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: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20130913000358 WA Practitioner - Nurse Practitioner 9537261110 Reassigns benefits to 1 organization

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
R1340646MNMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Wenatchee Valley Hospital Current Accepting new patients
Wenatchee Valley Hospital CurrentSince Aug 26, 2013 Accepting new patients

Locations

17 S Western Ave
Tonasket, WA 98855
Phone (509) 486-2174

1201 S Miller St
Wenatchee, WA 98801
Phone (509) 662-2208

820 N Chelan Ave
Wenatchee, WA 98801
Phone (509) 863-4868

100 Highline Dr
Wenatchee, WA 98802
Phone (509) 884-0614

933 Red Apple Rd
Wenatchee, WA 98801
Phone (509) 655-6125

Interoperability endpoints

  • Direct secure messaging: plarson18323@edirect.chehr.org

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": "1167350400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656460800000",
    "number": "1629134960",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 N CHELAN AVE",
            "city": "WENATCHEE",
            "state": "WA",
            "postal_code": "988012028"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 HIGHLINE DR",
            "city": "EAST WENATCHEE",
            "state": "WA",
            "postal_code": "988025341",
            "telephone_number": "509-884-0641"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "PAUL",
        "middle_name": "ROBERT",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-29",
        "last_updated": "2022-06-29",
        "certification_date": "2022-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MN",
            "license": "R1340646",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1629134960",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "316364",
            "state": "WA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "PLARSON18323@EDIRECT.CHEHR.ORG",
            "affiliation": "N",
            "address_1": "100 Highline Dr",
            "city": "East Wenatchee",
            "state": "WA",
            "country_code": "US",
            "postal_code": "988025341",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0764.epichosted.com/FHIRProxy/api/FHIR/R4/",
            "affiliation": "N",
            "address_1": "100 Highline Dr",
            "city": "East Wenatchee",
            "state": "WA",
            "country_code": "US",
            "postal_code": "988025341",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in East Wenatchee, WA

Sources for this page

Verify at the official NPI Registry.