Larsen Gastroenterology, PLLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

MD 00029346 Issued in WA

Legal business name

LARSEN GASTROENTEROLOGY, PLLC

Practice address

625 6TH St
Clarkston, WA 99403-2010

Phone

(509) 758-2200

NPI assigned

Mar 26, 2014

Organization subpart

No

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

Authorized official

Name

Michelle Marie Hastings

Title

Office Manager

Phone

(509) 758-2200

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Murray I Larsen, MD

  • Gastroenterology Physician
  • Clarkston, WA
  • NPI 1568451102
  Medicare reassignment
• Jennifer Altmiller Kaufman, NP

  • Nurse Practitioner
  • Clarkston, WA
  • NPI 1750405767
  NPD
• Chelsy Joy Sheppard, MSN, FNP, ARNP-C

  • Nurse Practitioner
  • Lewiston, ID
  • NPI 1568059681
  NPD

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

{
    "created_epoch": "1395792000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704758400000",
    "number": "1174940282",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "625 6TH ST",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032010",
            "telephone_number": "509-758-2200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 6TH ST",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032010",
            "telephone_number": "509-758-2200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LARSEN GASTROENTEROLOGY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-03-26",
        "last_updated": "2024-01-09",
        "certification_date": "2024-01-09",
        "status": "A",
        "authorized_official_last_name": "HASTINGS",
        "authorized_official_first_name": "MICHELLE",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "509-758-2200"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WA",
            "license": "MD 00029346",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2039081",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0027334",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jessica Elaine Krull
• Wendy Dee Kubacky
• Joy Jihyun Kwon, PHARMACIST
• Tabitha Labelle
• Mandy Lange
• Laure M Larsen, ARNP
• Murray I Larsen, MD
• Brooksie K Larson
• Julie K Larson, RN
• Kellie Lassiter

• Clinic/Center in Clarkston, WA
• Providers in Clarkston, WA by specialty
• Clinic/Center in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.