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Individual provider Active NPI

Larry David Carnes, PA-C

  • Medical Physician Assistant
  • Mount Vernon, WA
National Provider Identifier
1649238205
Registry record updated Feb 20, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Medical Physician AssistantTaxonomy code 363AM0700X
License
PA60507481 Issued in WA
Practice address
1400 E. Kincaid Street
Mount Vernon, WA 98274-4127
Phone
(360) 428-6434
Fax
(360) 858-4233
NPI assigned
May 3, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 20, 2015

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Medical Physician Assistant 363AM0700X
Medical Physician Assistant 363AM0700X PA60507481 WA Primary
Physician Assistant 363A00000X PA60507481 WA

Addresses

Primary practice location

1400 E. Kincaid Street
Mount Vernon, WA 98274-4127

Mailing address

1400 E. Kincaid Street
Attn: Credentialing
Mount Vernon, WA 98274-4127
Phone (360) 428-2500

Other identifiers 1

IdentifierTypeStateIssuer
1649238205MedicaidWA

Other names 1

  • L. David Carnes Professional name

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
I20150630001001 WA Practitioner - Physician Assistant 1658683909 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2001
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1300 NE Goldie St
Oak Harbor, WA 98277-4832

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA60507481WAMDMedical Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Public Hospital Dist No 1 Skagit CurrentSince May 1, 2015 Accepting new patients
Whidbey Island Public Hospital District Physician Assistant CurrentSince Nov 23, 2020 Accepting new patients
Whidbey Island Public Hospital District CurrentSince Nov 23, 2020 Accepting new patients
WGH Primary Care Associates, P.S. Current Accepting new patients

Locations

11245 State Route 525
Clinton, WA 98236
Phone (360) 341-5252

101 N Main St
Coupeville, WA 98239
Phone (360) 678-7656

1400 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 428-2586

2320 Freeway Dr
Mount Vernon, WA 98273
Phone (360) 814-6800

275 SE Cabot Dr
Ste B101
Oak Harbor, WA 98277
Phone (360) 675-6648

1300 NE Goldie St
Oak Harbor, WA 98277
Phone (360) 240-4070

Organizations & group practices 6

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.

Hospital & facility affiliations 6

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": "1146614400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1424390400000",
    "number": "1649238205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 E. KINCAID STREET",
            "address_2": "ATTN: CREDENTIALING",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744127",
            "telephone_number": "360-428-2500",
            "fax_number": "360-428-6485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 E. KINCAID STREET",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744127",
            "telephone_number": "360-428-6434",
            "fax_number": "360-858-4233"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CARNES",
        "first_name": "LARRY",
        "middle_name": "DAVID",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-03",
        "last_updated": "2015-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA60507481",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA60507481",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1649238205",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "L.",
            "last_name": "CARNES",
            "middle_name": "DAVID",
            "credential": "PA-C",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

Other providers in Mount Vernon, WA

Sources for this page

Verify at the official NPI Registry.