Willie Larson, CNM is a medicare enrolled "Advanced Practice Midwife" in Valley Village, California. Her current practice location is
5901 Rhodes Ave, Valley Village, California. You can reach out to her office (for appointments etc.) via phone at
(310) 869-0906.
Willie Larson is licensed to practice in California (license number 236523) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1053062943.
Provider's Profile
| Full Name | Willie Larson |
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| Gender | Female |
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| Speciality | Advanced Practice Midwife |
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| Location | 5901 Rhodes Ave, Valley Village, California |
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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: 1053062943
- Provider Enumeration Date: 01/12/2022
- Last Update Date: 03/11/2025
Medicare PECOS Information:
- PECOS PAC ID: 8820512957
- Enrollment ID: I20250409003771
Medical Identifiers
Medical identifiers for Willie Larson such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1053062943 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 163W00000X | Registered Nurse | 95229614 (California) | Secondary |
| 367A00000X | Advanced Practice Midwife | 236523 (California) | 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. Willie Larson allows following entities to bill medicare on her behalf.
| Entity Name | Obhg California Pc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1215258892
PECOS PAC ID: 8729276795
Enrollment ID: O20101217000826 |
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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. Willie 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 |
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Willie Larson, CNM
5901 Rhodes Ave,
Valley Village, CA 91607-1131
Ph: (310) 869-0906 | Willie Larson, CNM
5901 Rhodes Ave,
Valley Village, CA 91607-1131
Ph: (310) 869-0906 |
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