NPIMap

Individual provider Active NPI

Paul Larson

  • Family Medicine Physician
  • Cranston, RI
National Provider Identifier
1952547424
Registry record updated Jul 27, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
MD17835 Issued in RI
Practice address
1500 Pontiac Ave Ste 101
Cranston, RI 02920-4486
Phone
(401) 944-4330
Fax
(401) 464-4071
NPI assigned
Jan 5, 2009
Last updated
Jul 27, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 27, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X MD425506 PA
Family Medicine Physician 207Q00000X MD17835 RI Primary

Addresses

Primary practice location

1500 Pontiac Ave Ste 101
Cranston, RI 02920-4486

Mailing address

117 Ellenfield St Ste 101
Providence, RI 02905-4541
Phone (401) 444-6779

Other practice location 1

301 Eleventh St
Suite C
New Kensington, PA 15068-6179
Phone (724) 334-3640

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address paul.r.larson@upmcdirect.com UPMC

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210805002931 RI Practitioner - Family Practice 3971584046 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Massachusetts Medical School, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Coastal Medical Physicians IncGroup PAC ID 0345658316, 222 clinicians

Practice addresses (Care Compare)

1500 Pontiac Ave
Suite 101
Cranston, RI 02920-4486
Phone (401) 944-4300

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD425506PAMDFamily Medicine Physician
MD17835RIMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Coastal Medical Physicians, Inc. CurrentSince Feb 1, 2024 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Sep 1, 2021 Accepting new patients
Lifespan Physician Group, Inc. CurrentSince Sep 1, 2021 Accepting new patients
Coastal Medical Physicians, Inc. Family Medicine CurrentSince Feb 1, 2024 Accepting new patients
Lifespan Corporation Current Accepting new patients
Community Family Health Centers Inc Past Accepting new patients
Pefha Health & Wellness Center Family Medicine Past Accepting new patients
Washington Hospital Past Accepting new patients

Locations

1500 Pontiac Ave
Ste 101
Cranston, RI 02920
Phone (401) 371-0223

900 Warren Ave
Ste 401
East Providence, RI 02914
Phone (401) 330-2480

185A High Service Ave
North Providence, RI 02904
Phone (401) 354-6050

117 Ellenfield St
Ste 101
Providence, RI 02905
Phone (401) 444-4318

501 Centerville Rd
Ste 101
Warwick, RI 02886
Phone (401) 606-2680

Interoperability endpoints

  • Direct secure messaging: plarson199659@brownhealth.medalliesdirect.net

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

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": "1231113600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627344000000",
    "number": "1952547424",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "117 ELLENFIELD ST STE 101",
            "city": "PROVIDENCE",
            "state": "RI",
            "postal_code": "029054541",
            "telephone_number": "401-444-6779"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 PONTIAC AVE STE 101",
            "city": "CRANSTON",
            "state": "RI",
            "postal_code": "029204486",
            "telephone_number": "401-944-4330",
            "fax_number": "401-464-4071"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "301 Eleventh St",
            "address_2": "SUITE C",
            "address_purpose": "LOCATION",
            "city": "New Kensington",
            "state": "PA",
            "postal_code": "150686179",
            "country_code": "US",
            "telephone_number": "724-334-3640",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LARSON",
        "first_name": "PAUL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-01-05",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "PA",
            "license": "MD425506",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "RI",
            "license": "MD17835",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "paul.r.larson@upmcdirect.com",
            "affiliation": "Y",
            "affiliationName": "UPMC",
            "address_1": "600 Grant St",
            "address_2": "Floor 58",
            "city": "Pittsburgh",
            "state": "PA",
            "country_code": "US",
            "postal_code": "152192702",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Cranston, RI

Sources for this page

Verify at the official NPI Registry.