NPIMap

Individual provider Active NPI

Christopher Ryan Larson, PA-C

  • Physician Assistant
  • Riverview, FL
National Provider Identifier
1851623136
Registry record updated Sep 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA9115279 Issued in FL
Practice address
6901 Simmons Loop
Riverview, FL 33578-9498
Phone
(813) 302-8000
NPI assigned
Feb 11, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 21, 2022

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA9115279 FL Primary
Physician Assistant 363A00000X 11595 MN

Addresses

Primary practice location

6901 Simmons Loop
Riverview, FL 33578-9498

Mailing address

2502 W Saint Isabel St
Tampa, FL 33607-6318
Phone (813) 874-5707

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, FL, TX3 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20140811002672 MN Practitioner - Physician Assistant 7214161231 Reassigns benefits to 4 organizations
I20221011003010 FL Practitioner - Physician Assistant 7214161231 Reassigns benefits to 1 organization
I20251006002257 TX Practitioner - Physician Assistant 7214161231 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grand Itasca Clinic and HospitalGroup PAC ID 8123939550, 328 clinicians

Practice addresses (Care Compare)

111 SE 3Rd St
Grand Rapids, MN 55744-3663
Phone (218) 326-3401

1601 Golf Course Rd
Grand Rapids, MN 55744-8648
Phone (218) 326-3401

Hospital & facility affiliations

  • Grand Itasca Clinic and Hospital Hospital, Grand Rapids, MN, CCN 240064
  • Cass Lake Indian Health Services Hospital Hospital, Cass Lake, MN, CCN 241358
  • North Memorial Health Hospital Hospital, Robbinsdale, MN, CCN 240001

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2092MNMDSocial Worker
PA9115279FLMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Grand Itasca Clinic and Hospital CurrentSince Jan 1, 2022 Accepting new patients
Department of Health & Human Services PHS IHS CurrentSince Sep 8, 2025 Accepting new patients
Ecc Addiction & Toxicology Services LLC Past Accepting new patients

Locations

350 E Devon Ave
Itasca, IL 60143

425 7th St NW
Cass Lake, MN 56633
Phone (218) 335-3200

111 SE 3rd St
Grand Rapids, MN 55744
Phone (218) 326-3401

Interoperability endpoints

  • Direct secure messaging: clarson629731@fairview.direct-ci.com

Organizations & group practices 8

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": "1265846400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663718400000",
    "number": "1851623136",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2502 W SAINT ISABEL ST",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336076318",
            "telephone_number": "813-874-5707",
            "fax_number": "813-874-5908"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6901 SIMMONS LOOP",
            "city": "RIVERVIEW",
            "state": "FL",
            "postal_code": "335789498",
            "telephone_number": "813-302-8000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "CHRISTOPHER",
        "middle_name": "RYAN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-02-11",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "FL",
            "license": "PA9115279",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MN",
            "license": "11595",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Riverview, FL

Sources for this page

Verify at the official NPI Registry.