Individual provider Active NPI

Jeffrey Donald Larson, M.D.

  • Family Medicine Physician
  • Naperville, IL
National Provider Identifier
1144516097
Registry record updated Jun 14, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
125060226 Issued in IL
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

Updated by the provider on Jun 14, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

TypeEndpointUseAffiliation
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
Green means eligible to order or refer.

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
125060226ILMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Lawndale Christian Health Center CurrentSince Aug 5, 2014 Accepting new patients
Lawndale Christian Health Center Current Accepting new patients
Dupage Medical Group LTD CurrentSince Nov 4, 2021 Accepting new patients
Lawndale Christian Health Center Current Accepting new patients
Lawndale Christian Health Center CurrentSince Aug 5, 2014 Accepting new patients
Dupage Medical Group LTD CurrentSince Nov 4, 2021 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

  • Direct secure messaging: 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.

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

Verify at the official NPI Registry.