NPIMap

Individual provider Active NPI

Jeffrey E Larson, MD

  • Orthopaedic Surgery Physician
  • West Allis, WI
National Provider Identifier
1124018809
Registry record updated Dec 10, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthopaedic Surgery PhysicianTaxonomy code 207X00000X
License
31144020 Issued in WI
Practice address
2424 S 90TH St
Suite 500
West Allis, WI 53227-2455
Phone
(414) 328-8600
Fax
(414) 328-8686
NPI assigned
Oct 25, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 10, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthopaedic Surgery Physician 207X00000X 31144020 WI Primary

Addresses

Primary practice location

2424 S 90TH St
Suite 500
West Allis, WI 53227-2455

Mailing address

19475 W North Ave
Ste 201
Brookfield, WI 53045-4199
Phone (262) 395-4163

Other identifiers 2

IdentifierTypeStateIssuer
31597600MedicaidWI
CG1663OtherWIMEDICARE RAILROAD

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20091210000053 WI Practitioner - Orthopedic Surgery 5496894180 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Medical College of Wisconsin, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Aspen Orthopaedic and Rehabilitation Specialists S CGroup PAC ID 8325930480, 11 clinicians

Practice addresses (Care Compare)

17000 W N Ave
Suite 104W
Brookfield, WI 53005-4423
Phone (262) 799-5605

Hospital & facility affiliations

  • Aurora at Home Home health agency, Milwaukee, WI, CCN 527001
  • Ascension SE Wisconsin Hospital Hospital, Milwaukee, WI, CCN 520136
  • West Allis Memorial Hospital Hospital, West Allis, WI, CCN 520139
  • Waukesha Memorial Hospital Hospital, Waukesha, WI, CCN 520008
  • Orthopaedic Hospital of Wisconsin Hospital, Glendale, WI, CCN 520194
  • Aurora Medical Center - Summit Hospital, Summit, WI, CCN 520206

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement1-10
Knee replacement1-10
Lower limb (leg) arthroscopy (minimally invasive joint repair)1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
31144020WIMDOrthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Aspen Orthopedic and Rehabilation Specalist Orthopaedic Surgery PastSince Dec 15, 2019 Accepting new patients

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FFEGBD

Organizations & group practices 2

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1130198400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1575936000000",
    "number": "1124018809",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19475 W NORTH AVE",
            "address_2": "STE 201",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530454199",
            "telephone_number": "262-395-4163",
            "fax_number": "262-395-4159"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2424 S 90TH ST",
            "address_2": "SUITE 500",
            "city": "WEST ALLIS",
            "state": "WI",
            "postal_code": "532272455",
            "telephone_number": "414-328-8600",
            "fax_number": "414-328-8686"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "JEFFREY",
        "middle_name": "E",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-25",
        "last_updated": "2019-12-10",
        "certification_date": "2019-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "WI",
            "license": "31144020",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31597600",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD",
            "identifier": "CG1663",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in West Allis, WI

Sources for this page

Verify at the official NPI Registry.