Philip Robert Larson, RDN is a medicare enrolled "Dietitian, Registered" provider in Bristol, Maine. His current practice location is
25 Stoneybrook Ln, Bristol, Maine. You can reach out to his office (for appointments etc.) via phone at
(918) 914-3215.
Philip Robert Larson is licensed to practice in Oklahoma (license number 2697) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1568116309.
Healthcare Provider's Profile
| Full Name | Philip Robert Larson |
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| Gender | Male |
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| Speciality | Dietitian, Registered |
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| Location | 25 Stoneybrook Ln, Bristol, Maine |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1568116309
- Provider Enumeration Date: 02/10/2022
- Last Update Date: 02/23/2026
Medicare PECOS Information:
- PECOS PAC ID: 5991190332
- Enrollment ID: I20220321002293
Medical Identifiers
Medical identifiers for Philip Robert Larson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1568116309 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 133V00000X | Dietitian, Registered | 2697 (Oklahoma) | Primary |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Philip Robert Larson allows following entities to bill medicare on his behalf.
| Provider Name | Cherokee Nation |
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| Provider Type | Part B Supplier - Clinic/group Practice |
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| Provider Identifiers | NPI Number: 1780692723
PECOS PAC ID: 5799698742
Enrollment ID: O20031106000628 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Philip Robert Larson is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
|---|
Philip Robert Larson, RDN
25 Stoneybrook Ln,
Bristol, ME 04539-3050
Ph: (918) 914-3215 | Philip Robert Larson, RDN
25 Stoneybrook Ln,
Bristol, ME 04539-3050
Ph: (918) 914-3215 |
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