Active NPI
Larry Yoder, PA
- Medical Physician Assistant
- Lakeland, FL
National Provider Identifier
1972575744
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Medical Physician Assistant
- License
- PA1570
- Practice address
- 1600 Lakeland Hills Blvd
Lakeland, FL 33805 - Phone
- (863) 680-7000
- Fax
- (866) 264-8519
- NPI assigned
- Feb 6, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | PA1570 | FL | Primary |
Addresses
Primary practice location
1600 Lakeland Hills Blvd
Lakeland, FL 33805
Mailing address
PO Box 95004
Lakeland, FL 33804
Phone (863) 680-7206
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 290109900 | Medicaid | FL |
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 |
|---|---|---|---|
| PA1570 | FL | MD | Medical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Watson Clinic LLP | 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.
-
- Clinical Medical Laboratory
- Lakeland, FL
- NPI 1558409730
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340236800000",
"number": "1972575744",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 95004",
"city": "LAKELAND",
"state": "FL",
"postal_code": "33804",
"telephone_number": "863-680-7206",
"fax_number": "863-680-7420"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 LAKELAND HILLS BLVD",
"city": "LAKELAND",
"state": "FL",
"postal_code": "33805",
"telephone_number": "863-680-7000",
"fax_number": "866-264-8519"
}
],
"practiceLocations": [],
"basic": {
"last_name": "YODER",
"first_name": "LARRY",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-06",
"last_updated": "2012-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "363AM0700X",
"taxonomy_group": "",
"desc": "Physician Assistant, Medical",
"state": "FL",
"license": "PA1570",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "290109900",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lakeland, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.