DR. SHANE LYLE LARSON M.D.
NPI 1750601191
Family Medicine - Sports Medicine in Fort Eustis, VA

Q: What is Shane Larson's NPI number?

The NPI number for Shane Larson is 1750601191. It was assigned to this individual provider in the NPPES registry on June 8, 2010.

Q: What is Shane Larson's specialty?

The primary specialty registered for this NPI is Family Medicine, specializing in Sports Medicine, with taxonomy code 207QS0010X.

Q: When was this NPI record last updated?

The NPPES record for Shane Larson was last updated on April 27, 2022. NPI Profile syncs with the weekly NPPES data releases published by CMS.

Active since June 08, 2010PECOS Enrolled

576 JEFFERSON AVE, FORT EUSTIS, VA 23604(757) 820-1043(757) 820-1122 Get Directions Write a Review

NPPES record last updated: April 27, 2022. Verified against the NPPES registry weekly; last sync: July 26, 2026.

Record update history: Apr 27, 2022, Jun 11, 2019, May 31, 2019 (3 updates tracked since 2019).

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About Dr. Shane Lyle Larson M.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. SHANE LYLE LARSON M.D. (NPI 1750601191) is an individual sports medicine provider in Fort Eustis, Virginia, licensed in Georgia (67238) and active in the NPI registry since June 2010. He is enrolled in Medicare PECOS and maintains a secondary practice location in Fort Bragg.

NPPES Registry Identity

NPI1750601191

Entity TypeIndividualMale

Primary Taxonomy207QS0010X

Provider Legal NameDR. SHANE LYLE LARSONCredential: M.D.

Location Address576 JEFFERSON AVEFort Eustis, VA 23604-1373

Mailing Address576 Jefferson AveFort Eustis, VA 23604-1373 · (757) 820-1043 · Fax (757) 820-1122

Phone(757) 820-1043

Fax(757) 820-1122

Sole ProprietorNo

Enumeration DateJune 8, 2010

Last NPPES UpdateApril 27, 20223 updates tracked since enumeration

NPPES CertifiedApril 27, 2022

✔ NPI 1750601191 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyFamily Medicine · Sports MedicineAllopathic & Osteopathic Physicians

Taxonomy Code207QS0010X

License✔ Licensed in GA · 67238

Definition

A family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of health and fitness, but also for the prevention of injury and illness. A sports medicine physician must have knowledge and experience in the promotion of wellness and the prevention of injury. Knowledge about special areas of medicine such as exercise physiology, biomechanics, nutrition, psychology, physical rehabilitation, epidemiology, physical evaluation, injuries (treatment and prevention and referral practice) and the role of exercise in promoting a healthy lifestyle are essential to the practice of sports medicine. The sports medicine physician requires special education to provide the knowledge to improve the health care of the individual engaged in physical exercise (sports) whether as an individual or in team participation.

Also ListedFamily MedicineTaxonomy 207Q00000X · License 67238 (GA)

576 JEFFERSON AVE, Fort Eustis, VA 23604

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Secondary Practice Location 1

Location 12817 Reilly RoadFORT BRAGG, NC 28310 · Phone (910) 643-1427

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Molina Healthcare.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dr. Shane Lyle Larson M.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 23604 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$86.88 typical visit price

range $56.19 – $170.30

Typical copayment $21.72 (range $14.04 – $42.57)

Most-billed visit code 99203

Established Patient

$99.13 typical visit price

range $18.07 – $138.91

Typical copayment $24.78 (range $4.51 – $34.72)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MS. SAMANTHA NICHOLE ROBERT LPTA

Physical Therapy Assistant

576 JEFFERSON AVE, MCDONALD ARMY HEALTH CENTER
FORT EUSTIS, VA 23604

Newport News City (757) 314-7616

KATHRYN GRACE MCCARN PT, DPT

Physical Therapist