Individual provider Active NPI

Eric Jacob Larsen, DNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Mount Vernon, WA
National Provider Identifier
1205490661
Registry record updated Oct 6, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
AP60956123 Issued in WA
Practice address
1415 E Kincaid St
Mount Vernon, WA 98274-4126
Phone
(360) 424-4111
NPI assigned
Apr 30, 2019
Last updated
Oct 6, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 6, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Nurse Practitioner 363LP0808X AP60956123 WA Primary

Addresses

Primary practice location

1415 E Kincaid St
Mount Vernon, WA 98274-4126

Mailing address

1415 E Kincaid St
Mount Vernon, WA 98274-4126

Other practice location 1

811 Madison St
Everett, WA 98203-4543
Phone (425) 212-4200

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address elarsen29135@skagit.direct-ci.com Direct

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190830001672 WA Practitioner - Nurse Practitioner 8628307519 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2019
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Public Hospital Dist No 1 SkagitGroup PAC ID 6800793522, 321 clinicians

Practice addresses (Care Compare)

1415 E Kincaid St
Mount Vernon, WA 98274-4126
Phone (360) 416-5750

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
AP60956123WAMDPsychiatric/Mental Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Public Hospital Dist No 1 Skagit CurrentSince Nov 1, 2019 Accepting new patients
Public Hospital Dist No 1 Skagit Current Accepting new patients
Shifa Health PLLC CurrentSince Dec 31, 2019 Accepting new patients
Public Hospital Dist No 1 Skagit Past Accepting new patients

Locations

10333 19th Ave SE
Ste 109
Everett, WA 98208
Phone (425) 742-4600

1103 Cleveland Ave
Mount Vernon, WA 98273
Phone (360) 336-6868

1415 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 416-5750

1400 E Kincaid St
Mount Vernon, WA 98274
Phone (360) 428-2586

Interoperability endpoints

  • Direct secure messaging: elarsen29135@skagit.direct-ci.com

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

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": "1556582400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633478400000",
    "number": "1205490661",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1415 E KINCAID ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744126"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1415 E KINCAID ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744126",
            "telephone_number": "360-424-4111"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "811 Madison St",
            "address_purpose": "LOCATION",
            "city": "Everett",
            "state": "WA",
            "postal_code": "982034543",
            "country_code": "US",
            "telephone_number": "425-212-4200",
            "fax_number": "425-212-4201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "ERIC",
        "middle_name": "JACOB",
        "credential": "DNP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-04-30",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "WA",
            "license": "AP60956123",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "elarsen29135@skagit.direct-ci.com",
            "affiliation": "N",
            "endpointDescription": "Provider Direct Address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "1415 E Kincaid St",
            "city": "Mount Vernon",
            "state": "WA",
            "country_code": "US",
            "postal_code": "982744126",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Mount Vernon, WA

Sources for this page

Verify at the official NPI Registry.