Active NPI
Larry Brian Feldman, M.D.
- Psychiatry Physician
- Lakeside, MI
National Provider Identifier
1689704207
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 4301081108
- Practice address
- 8800 Blackhawk Dr
Lakeside, MI 49116-9746 - Phone
- (269) 921-0531
- NPI assigned
- Mar 6, 2007
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 4301081108 | MI | Primary |
Addresses
Primary practice location
8800 Blackhawk Dr
Lakeside, MI 49116-9746
Mailing address
PO Box 57
Lakeside, MI 49116-0057
Phone (269) 921-0531
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4301081108 | MI | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Beacon Counseling Center LLC | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Mental Health Counselor
- Saint Joseph, MI
- NPI 1114218807
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173139200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1689704207",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 57",
"city": "LAKESIDE",
"state": "MI",
"postal_code": "491160057",
"telephone_number": "269-921-0531"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8800 BLACKHAWK DR",
"city": "LAKESIDE",
"state": "MI",
"postal_code": "491169746",
"telephone_number": "269-921-0531"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FELDMAN",
"first_name": "LARRY",
"middle_name": "BRIAN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-06",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MI",
"license": "4301081108",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.