Active NPI
Larry Croom Jr.
- Behavior Technician
- Las Vegas, NV
National Provider Identifier
1669918561
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 814779557
- Practice address
- 5836 S Pecos Rd
Las Vegas, NV 89120-3418 - Phone
- (800) 829-4933
- NPI assigned
- Jan 16, 2017
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 814779557 | NV | Primary |
Addresses
Primary practice location
5836 S Pecos Rd
Las Vegas, NV 89120-3418
Mailing address
5836 S Pecos Rd
Las Vegas, NV 89120-3418
Phone (800) 829-4933
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 814779557 | Medicaid | NV |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 814779557 | NV | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1484524800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484524800000",
"number": "1669918561",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5836 S PECOS RD",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891203418",
"telephone_number": "800-829-4933"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5836 S PECOS RD",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "891203418",
"telephone_number": "800-829-4933"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROOM",
"first_name": "LARRY",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-01-16",
"last_updated": "2017-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "NV",
"license": "814779557",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "814779557",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.