Active NPI
Jeffrey R Larson, CRNP
- Nurse Practitioner
- Erie, PA
National Provider Identifier
1679553937
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- SP007048
- Practice address
- 201 State St
Erie, PA 16550-0002 - Phone
- (814) 877-6139
- Fax
- (814) 877-6093
- NPI assigned
- Jan 20, 2006
- Last updated
- May 23, 2012
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | SP007048 | PA | Primary |
Addresses
Primary practice location
201 State St
Erie, PA 16550-0002
Mailing address
717 State St
Suite 16, LL
Erie, PA 16501-1341
Phone (814) 877-7100
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3000584 | Other | WV | WEST VIRGINIA WORK COMP |
| 02799186 | Other | NY | NY MEDICAL ASSISTANC |
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)
- Enrolled
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Regional Health Services Inc | Past | Accepting new patients | |
| Upmc Hamot | Past | Accepting new patients | |
| Erie Physicians Network PC | Past | Accepting new patients |
Organizations & group practices 3
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.
-
- Multi-Specialty Clinic/Center
- Erie, PA
- NPI 1902844574
-
- Family Medicine Physician
- Erie, PA
- NPI 1174520654
-
- General Acute Care Hospital
- Erie, PA
- NPI 1538207394
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137715200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1337731200000",
"number": "1679553937",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "717 STATE ST",
"address_2": "SUITE 16, LL",
"city": "ERIE",
"state": "PA",
"postal_code": "165011341",
"telephone_number": "814-877-7100",
"fax_number": "814-877-2939"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "201 STATE ST",
"city": "ERIE",
"state": "PA",
"postal_code": "165500002",
"telephone_number": "814-877-6139",
"fax_number": "814-877-6093"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "JEFFREY",
"middle_name": "R",
"name_prefix": "Mr.",
"credential": "CRNP",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-20",
"last_updated": "2012-05-23",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "PA",
"license": "SP007048",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WEST VIRGINIA WORK COMP",
"identifier": "3000584",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NY MEDICAL ASSISTANC",
"identifier": "02799186",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Erie, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.