Derek R Larson, LCSW
Individual provider Active NPI Clinical Social Worker · Hill Afb, UT
NPI 1194731091 · NPPES record last updated Dec 3, 2024
Key facts
- NPI
- 1194731091
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- 4941733-3501 (UT)
- Practice address
- 75TH Medical Group
7321 Balmer Street Building 570
Hill Afb, UT 84056 - Phone
- (801) 777-7909
- NPI assigned
- Jul 31, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Clinical Social Worker
- Education
- Other, 2003
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ihc Health Services Inc
Practice addresses (Care Compare)
700 S Hwy 99
Fillmore, UT 84631-5134
Phone (435) 743-5555
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070731000582 | UT | Practitioner - Clinical Social Worker | 3678664968 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4941733-3501 | UT | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ihc Health Services Inc | Current | Accepting new patients | |
| Ihc Health Services Inc | Current |
Accepting new patients | |
| Ihc Health Services Inc | Current | Accepting new patients | |
| Ihc Health Services Inc | Current |
Accepting new patients | |
| Ihc Health Services, Inc. | Current |
Accepting new patients |
Locations
700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555
700 S Highway 99
Fillmore, UT 84631
Phone (435) 743-5555
5770 S 250 E
Ste 300
Salt Lake City, UT 84107
Phone (801) 314-2500
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 4941733-3501 | UT | Yes |
Addresses
Primary practice location
75TH Medical Group
7321 Balmer Street Building 570
Hill Afb, UT 84056
Mailing address
75TH Medical Group
7321 Balmer Street Building 570
Hill Afb, UT 84056
Phone (801) 777-7909
Other practice location 1
5770 S 250 E Ste 300
Murray, UT 84107-8110
Phone (801) 314-2500
Other providers in Hill Afb, UT
- Kelly Johnson
- Vanessa Jones
- Daniel Jacob Kardouni
- Eric Ford Kebker
- John David Larsen
- Nathan Michael Leeman
- Tracy Amy Louie
- Staci Lynne Maclean
- Chloe Marie Mager
- Shauna Rae Mayer
All providers in Hill Afb, UT · Clinical Social Worker in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.