Organization Active NPI

Larry R Bachle DO Facoep PA

  • Undersea and Hyperbaric Medicine (Emergency Medicine) Physician
  • Punta Gorda, FL
National Provider Identifier
1811947302
Registry record updated Apr 15, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Undersea and Hyperbaric Medicine (Emergency Medicine) PhysicianTaxonomy code 207PE0005X
License
OS6291 Issued in FL
Legal business name
LARRY R BACHLE DO FACOEP PA
Practice address
25097 Olympia Ave
Suite 107
Punta Gorda, FL 33950-3903
Phone
(941) 205-2620
Fax
(941) 205-2630
NPI assigned
May 12, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 15, 2013

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

Authorized official

Name
Dr. Larry R Bachle, DO FACOEP
Title
Physician
Phone
(941) 764-9560

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Undersea and Hyperbaric Medicine (Emergency Medicine) PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207PE0005X OS6291 FL Primary

Addresses

Primary practice location

25097 Olympia Ave
Suite 107
Punta Gorda, FL 33950-3903

Mailing address

PO Box 510669
Punta Gorda, FL 33951-0669
Phone (941) 764-9560

Other identifiers 3

IdentifierTypeStateIssuer
37095230MedicaidFL
P00316034OtherFLRR MEDICARE
DE7887OtherFLRR MEDICARE GRP #

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060505000695 FL Part B Supplier - Clinic/Group Practice 6002827078 Receives reassigned benefits from 1 practitioner
Practice locations: Punta Gorda, FL

National Provider Directory

National Provider Directory

Locations

24451 Sandhill Blvd
#A
Punta Gorda, FL 33983
Phone (941) 629-3435

25097 Olympia Ave
Ste 107
Punta Gorda, FL 33950
Phone (941) 205-2620

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1365984000000",
    "number": "1811947302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 510669",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "339510669",
            "telephone_number": "941-764-9560",
            "fax_number": "941-205-2630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "25097 OLYMPIA AVE",
            "address_2": "SUITE 107",
            "city": "PUNTA GORDA",
            "state": "FL",
            "postal_code": "339503903",
            "telephone_number": "941-205-2620",
            "fax_number": "941-205-2630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARRY R BACHLE DO FACOEP PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2013-04-15",
        "status": "A",
        "authorized_official_last_name": "BACHLE",
        "authorized_official_first_name": "LARRY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "941-764-9560",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO FACOEP"
    },
    "taxonomies": [
        {
            "code": "207PE0005X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine, Undersea and Hyperbaric Medicine",
            "state": "FL",
            "license": "OS6291",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "37095230",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00316034",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE GRP #",
            "identifier": "DE7887",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Punta Gorda, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 15, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.