Active NPI
Jeffrey Donald Larson, M.D.
- Family Medicine Physician
- Naperville, IL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 125060226
- Practice address
- 808 Rickert Dr Ste 103
Naperville, IL 60540-0908 - Phone
- (331) 551-5854
- Fax
- (630) 348-3098
- NPI assigned
- Jun 20, 2011
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 125060226 | IL | Primary |
Addresses
Primary practice location
808 Rickert Dr Ste 103
Naperville, IL 60540-0908
Mailing address
1860 Paysphere Cir
Chicago, IL 60674-0018
Phone (630) 469-9200
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jlarson235429@dulyhealthandcare.direct-ci.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 125060226 | IL | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Lawndale Christian Health Center | Current | Accepting new patients | |
| Lawndale Christian Health Center | Current | Accepting new patients | |
| Dupage Medical Group LTD | Current | Accepting new patients | |
| Lawndale Christian Health Center | Current | Accepting new patients | |
| Lawndale Christian Health Center | Current | Accepting new patients | |
| Dupage Medical Group LTD | Current | Accepting new patients |
Locations
30 Stratford Dr
Bloomingdale, IL 60108
Phone (630) 893-2210
3860 W Ogden Ave
Chicago, IL 60623
Phone (872) 588-3000
4696 Paysphere Cir
Chicago, IL 60674
1860 Paysphere Cir
Chicago, IL 60674
Phone (630) 469-2000
808 Rickert Dr
Naperville, IL 60540
Phone (630) 322-8300
808 Rickert Dr
Ste 103
Naperville, IL 60540
Phone (331) 551-5854
Interoperability endpoints
- jlarson235429@dulyhealthandcare.direct-ci.com
Organizations & group practices 6
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.
-
- Durable Medical Equipment & Medical Supplies
- Glen Ellyn, IL
- NPI 1760979447
-
- Multi-Specialty Clinic/Center
- Downers Grove, IL
- NPI 1801833983
-
- Federally Qualified Health Center (FQHC)
- Chicago, IL
- NPI 1245289214
-
- Federally Qualified Health Center (FQHC)
- Chicago, IL
- NPI 1326215450
-
- Health Educator
- Chicago, IL
- NPI 1588537641
-
- Community/Retail Pharmacy
- Chicago, IL
- NPI 1679680235
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1308528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1655164800000",
"number": "1144516097",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1860 PAYSPHERE CIR",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606740018",
"telephone_number": "630-469-9200"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "808 RICKERT DR STE 103",
"city": "NAPERVILLE",
"state": "IL",
"postal_code": "605400908",
"telephone_number": "331-551-5854",
"fax_number": "630-348-3098"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "JEFFREY",
"middle_name": "DONALD",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-20",
"last_updated": "2022-06-14",
"certification_date": "2022-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "IL",
"license": "125060226",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jlarson235429@dulyhealthandcare.direct-ci.com",
"affiliation": "N",
"address_1": "808 Rickert Dr Ste 103",
"city": "Naperville",
"state": "IL",
"country_code": "US",
"postal_code": "605400908",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Naperville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.