Active NPI
Julie N. Larsen, M.D.
- Family Medicine Physician
- Sussex, WI
National Provider Identifier
1174596787
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 27016
- Practice address
- N57W24950 N Corporate Cir
Sussex, WI 53089-4383 - Phone
- (262) 820-3093
- NPI assigned
- Feb 13, 2006
- Sex
- Female
- 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 | 27016 | WI | Primary |
Addresses
Primary practice location
N57W24950 N Corporate Cir
Sussex, WI 53089-4383
Mailing address
N57W24950 N Corporate Cir
Sussex, WI 53089-4383
Phone (262) 820-3093
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30668200 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 27016 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Prohealth Medical Group Inc | Family Medicine | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Family Medicine Physician
- Waukesha, WI
- NPI 1790720613
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1139788800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1334880000000",
"number": "1174596787",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "N57W24950 N CORPORATE CIR",
"city": "SUSSEX",
"state": "WI",
"postal_code": "530894383",
"telephone_number": "262-820-3093"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "N57W24950 N CORPORATE CIR",
"city": "SUSSEX",
"state": "WI",
"postal_code": "530894383",
"telephone_number": "262-820-3093"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSEN",
"first_name": "JULIE",
"middle_name": "N.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-02-13",
"last_updated": "2012-04-20",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WI",
"license": "27016",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "30668200",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Sussex, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.