Active NPI
Larry Renn Carpenter, PA-C
- Medical Physician Assistant
- Davenport, WA
National Provider Identifier
1912982901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- Practice address
- 100 3Rd St Ste 1
Davenport, WA 99122-5008 - Phone
- (509) 725-7501
- Fax
- (509) 725-7501
- NPI assigned
- Dec 13, 2005
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA60136165 | WA | |
| Medical Physician Assistant | 363AM0700X | Primary |
Addresses
Primary practice location
100 3Rd St Ste 1
Davenport, WA 99122-5008
Mailing address
100 3Rd St Ste 1
Davenport, WA 99122-5008
Phone (509) 725-7501
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2005809 | Medicaid | WA | |
| 295800 | Other | WA | WASHINGTON STATE DEPT OF LABOR & INDUSTRIES |
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
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA60136165 | WA | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eagle Mountain Family Medicine. 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.
-
- Family Medicine Physician
- Saratoga Springs, UT
- NPI 1316012628
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1134432000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1584921600000",
"number": "1912982901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 3RD ST STE 1",
"city": "DAVENPORT",
"state": "WA",
"postal_code": "991225008",
"telephone_number": "509-725-7501",
"fax_number": "509-725-7501"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 3RD ST STE 1",
"city": "DAVENPORT",
"state": "WA",
"postal_code": "991225008",
"telephone_number": "509-725-7501",
"fax_number": "509-725-7501"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CARPENTER",
"first_name": "LARRY",
"middle_name": "RENN",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-12-13",
"last_updated": "2020-03-23",
"certification_date": "2020-03-23",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WA",
"license": "PA60136165",
"primary": false
},
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2005809",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "WASHINGTON STATE DEPT OF LABOR & INDUSTRIES",
"identifier": "295800",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Davenport, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.