NPIMap

Individual provider Active NPI

Michael Edward Larson, MD

  • Diagnostic Radiology Physician
  • Madison, WI
National Provider Identifier
1174054670
Registry record updated Aug 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
71888-20 Issued in WI
Practice address
Uw Hospitals & Clinics 600 Highland Ave
Madison, WI 53792
Phone
(262) 893-0613
NPI assigned
Mar 26, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 71888-20 WI Primary

Addresses

Primary practice location

Uw Hospitals & Clinics 600 Highland Ave
Madison, WI 53792

Mailing address

Radiology Waukesha, S.C.
1336 Park Ave
South Milwaukee, WI 53172-1133
Phone (414) 940-0278

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI, TX2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20230823002954 WI Practitioner - Diagnostic Radiology 2466700331 Reassigns benefits to 3 organizations
I20230901000380 TX Practitioner - Diagnostic Radiology 2466700331 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Medical College of Wisconsin, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Prohealth Medical Group IncGroup PAC ID 3476465188, 475 clinicians
Radiology Waukesha SCGroup PAC ID 3274520648, 29 clinicians

Practice addresses (Care Compare)

1111 Delafield St
Suite 112
Waukesha, WI 53188-3402
Phone (262) 542-9212

725 American Ave
Waukesha, WI 53188-5031
Phone (262) 928-2400

Hospital & facility affiliations

  • Waukesha Memorial Hospital Hospital, Waukesha, WI, CCN 520008
  • Oconomowoc Memorial Hospital Hospital, Oconomowoc, WI, CCN 520062
  • Watertown Memorial Hospital Hospital, Watertown, WI, CCN 520116
  • Ascension SE Wisconsin Hospital Hospital, Milwaukee, WI, CCN 520136
  • Aurora Medical Center - Summit Hospital, Summit, WI, CCN 520206

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Alaska Native Tribal Health Consortium Current Accepting new patients
Radiology Consultants a Professional Corp Diagnostic Radiology CurrentSince Oct 23, 2023 Accepting new patients
Radiology Waukesha S.C. Diagnostic Radiology CurrentSince Aug 14, 2023 Accepting new patients
Prohealth Medical Group Inc. CurrentSince Aug 1, 2023 Accepting new patients
Tanana Chiefs Conference CurrentSince Jun 22, 2023 Accepting new patients
Prohealth Medical Group Inc CurrentSince Aug 1, 2023 Accepting new patients
Tanana Chiefs Conference CurrentSince Jun 22, 2023 Accepting new patients
Prohealth Medical Group Inc Past Accepting new patients

Locations

1717 W Cowles St
Fairbanks, AK 99701
Phone (907) 452-6682

125 Hospital Dr
Watertown, WI 53098
Phone (920) 261-4210

N14W23900 Stone Ridge Dr
Waukesha, WI 53188
Phone (262) 549-3030

N17W24100 Riverwood Dr
Waukesha, WI 53188
Phone (262) 820-3093

725 American Ave
Waukesha, WI 53188
Phone (262) 544-2011

1111 Delafield St
Ste 112
Waukesha, WI 53188
Phone (262) 542-9173

N16W24131 Riverwood Dr
Waukesha, WI 53188
Phone (262) 696-0696

Interoperability endpoints

  • Direct secure messaging: melarson1@direct.anthc.org

Organizations & group practices 8

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 7

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": "1490486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690934400000",
    "number": "1174054670",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "RADIOLOGY WAUKESHA, S.C.",
            "address_2": "1336 PARK AVE",
            "city": "SOUTH MILWAUKEE",
            "state": "WI",
            "postal_code": "531721133",
            "telephone_number": "414-940-0278",
            "fax_number": "414-301-9508"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "UW HOSPITALS & CLINICS 600 HIGHLAND AVE",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "53792",
            "telephone_number": "262-893-0613"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "MICHAEL",
        "middle_name": "EDWARD",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-26",
        "last_updated": "2023-08-02",
        "certification_date": "2023-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "WI",
            "license": "71888-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, WI

Sources for this page

Verify at the official NPI Registry.