NPIMap

Individual provider Active NPI

Larisa A. Sychova, FNP

  • Family Nurse Practitioner
  • Springfield, MO
National Provider Identifier
1992147169
Registry record updated Sep 3, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
2013027044 Issued in MO
Practice address
4922 S Bellhurst Ave
Springfield, MO 65804-7824
Phone
(256) 343-8078
NPI assigned
Jul 29, 2013
Last updated
Sep 3, 2020By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 3, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 2013027044 MO Primary

Addresses

Primary practice location

4922 S Bellhurst Ave
Springfield, MO 65804-7824

Mailing address

4922 S Bellhurst Ave
Springfield, MO 65804-7824
Phone (256) 343-8078

Other identifiers 2

IdentifierTypeStateIssuer
1992147169MedicaidMO
420008106MedicaidMO

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20201110001713 CO Practitioner - Nurse Practitioner 5698902286 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1400 E Boulder
Colorado Springs, CO 80909-5533
Phone (719) 776-5000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
2013027044MOMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Peak Vista Community Health Centers CurrentSince Jul 1, 2021 Accepting new patients
Peak Vista Community Health Centers CurrentSince Jul 1, 2021 Accepting new patients
Peak Vista Community Health Centers Past Accepting new patients
Advocates for a Healthy Community, Inc. Past Accepting new patients

Locations

1400 E Boulder St
Colorado Springs, CO 80909
Phone (719) 365-5120

3205 N Academy Blvd
Ste 130
Colorado Springs, CO 80917
Phone (719) 344-6873

Interoperability endpoints

  • Direct secure messaging: larisa.sychova.p1@direct.peakvista.nextgenshare.com

Organizations & group practices 4

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 18

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

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1375056000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599091200000",
    "number": "1992147169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4922 S BELLHURST AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658047824",
            "telephone_number": "256-343-8078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4922 S BELLHURST AVE",
            "city": "SPRINGFIELD",
            "state": "MO",
            "postal_code": "658047824",
            "telephone_number": "256-343-8078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SYCHOVA",
        "first_name": "LARISA",
        "middle_name": "A.",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-07-29",
        "last_updated": "2020-09-03",
        "certification_date": "2020-09-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MO",
            "license": "2013027044",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1992147169",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "420008106",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, MO

Sources for this page

Verify at the official NPI Registry.