Active NPI
Justin Lars Larson, CDCA, CPRS
- Peer Specialist
- Girard, OH
National Provider Identifier
1922570100
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Peer Specialist
- License
- 00566
- Practice address
- 412 Ohio Ave
Girard, OH 44420-3244 - Phone
- (330) 314-6647
- NPI assigned
- Dec 27, 2018
- 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 |
|---|---|---|---|---|
| Peer Specialist | 175T00000X | 00566 | OH | Primary |
Addresses
Primary practice location
412 Ohio Ave
Girard, OH 44420-3244
Mailing address
412 Ohio Ave
Girard, OH 44420-3244
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00566 | OH | MD | Peer Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1545868800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1545868800000",
"number": "1922570100",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "412 OHIO AVE",
"city": "GIRARD",
"state": "OH",
"postal_code": "444203244"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "412 OHIO AVE",
"city": "GIRARD",
"state": "OH",
"postal_code": "444203244",
"telephone_number": "330-314-6647"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "JUSTIN",
"middle_name": "LARS",
"credential": "CDCA, CPRS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-12-27",
"last_updated": "2018-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "175T00000X",
"taxonomy_group": "",
"desc": "Peer Specialist",
"state": "OH",
"license": "00566",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Girard, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.