Lara Gavaldon, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

5601009763 Issued in MI

Practice address

6227 Frankfort Hwy
Benzonia, MI 49616-8632

Phone

(231) 882-9661

NPI assigned

Jan 9, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: laragavaldon@clhcmi.allscriptsdirect.net

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.

• Crystal Lake Clinic PC

  • Family Medicine Physician
  • Manistee, MI
  • NPI 1134491731
  Medicare reassignment
• Crystal Lake Clinic P.C.

  • Family Medicine Physician
  • Suttons Bay, MI
  • NPI 1164945978
  NPD
• Crystal Lake Clinic, P.C.

  • Family Medicine Physician
  • Bear Lake, MI
  • NPI 1902851777
  NPD
• Crystal Lake Clinic P.C.

  • Family Medicine Physician
  • Interlochen, MI
  • NPI 1417902057
  NPD (past)
• Crystal Lake Clinic, P.C.

  • Family Medicine Physician
  • Kingsley, MI
  • NPI 1316177611
  NPD (past)

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

{
    "created_epoch": "1578528000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591833600000",
    "number": "1962042796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6227 FRANKFORT HWY",
            "city": "BENZONIA",
            "state": "MI",
            "postal_code": "496168632",
            "telephone_number": "231-882-9661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6227 FRANKFORT HWY",
            "city": "BENZONIA",
            "state": "MI",
            "postal_code": "496168632",
            "telephone_number": "231-882-9661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GAVALDON",
        "first_name": "LARA",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-01-09",
        "last_updated": "2020-06-11",
        "certification_date": "2020-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601009763",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erica Embury
• Shannon Dawn Farber
• Janine Felice-Johnson, D.C.
• Janis Lyn Frazee, RNC MSN
• Colleen Reed Freund, DDS
• Jacob Bruce Gideon
• Melinda K Gilland, LBSW
• Diane Gorno, LLBSW
• Logan Gray
• Heath A Green, LBSW, MA

• Physician Assistant in Benzonia, MI
• Providers in Benzonia, MI by specialty
• Physician Assistant in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.