NPIMap

Individual provider Active NPI

Brian Edward Larson, DC

  • Chiropractor
  • Soldotna, AK
National Provider Identifier
1952473415
Registry record updated Mar 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
ChiropractorTaxonomy code 111N00000X
License
396 Issued in AK
Practice address
189 S Binkley St
Suite 101
Soldotna, AK 99669-8007
Phone
(907) 262-0801
Fax
(907) 262-0860
NPI assigned
Nov 13, 2006
Last updated
Mar 28, 2013By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Chiropractor 111N00000X 396 AK Primary

Addresses

Primary practice location

189 S Binkley St
Suite 101
Soldotna, AK 99669-8007

Mailing address

189 S Binkley St
Suite 101
Soldotna, AK 99669-8007
Phone (907) 262-0801

Other identifiers 1

IdentifierTypeStateIssuer
CH0070MedicaidAK

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20060112000030 AK Practitioner - Chiropractic 5092733022 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Chiropractic
Education
Western States College of Chiropractic, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Premier Sports Medicine IncGroup PAC ID 9234523127, 2 clinicians

Practice addresses (Care Compare)

35670 Kenai Spur Hwy
Suite 104
Soldotna, AK 99669-7649
Phone (907) 262-0801

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Premier Sports Medicine, Inc. CurrentSince Jan 1, 2022 Accepting new patients

Locations

35670 Kenai Spur Hwy
#104
Soldotna, AK 99669
Phone (907) 260-6501

35670 Kenai Spur Hwy
Ste 104
Soldotna, AK 99669
Phone (907) 262-0801

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 19

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 19

NPI Registry JSON

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

{
    "created_epoch": "1163376000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1364428800000",
    "number": "1952473415",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "189 S BINKLEY ST",
            "address_2": "SUITE 101",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996698007",
            "telephone_number": "907-262-0801",
            "fax_number": "907-262-0860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "189 S BINKLEY ST",
            "address_2": "SUITE 101",
            "city": "SOLDOTNA",
            "state": "AK",
            "postal_code": "996698007",
            "telephone_number": "907-262-0801",
            "fax_number": "907-262-0860"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "BRIAN",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "DC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-13",
        "last_updated": "2013-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "AK",
            "license": "396",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "CH0070",
            "state": "AK"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Soldotna, AK

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.