NPIMap

Individual provider Active NPI

Stephen Larsen, M.D.

  • Urology Physician
  • Goodyear, AZ
National Provider Identifier
1215165584
Registry record updated Jan 18, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
50775 Issued in AZ
Practice address
13555 W McDowell Rd
302
Goodyear, AZ 85395-2624
Phone
(623) 512-4390
Fax
(623) 512-4391
NPI assigned
Jun 25, 2009
Last updated
Jan 18, 2017By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 18, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X 125-056789 IL
Urology Physician 208800000X 50775 AZ Primary

Addresses

Primary practice location

13555 W McDowell Rd
302
Goodyear, AZ 85395-2624

Mailing address

17560 N 75TH Ave
Suite 440
Glendale, AZ 85308-5983
Phone (623) 512-4390

Other identifiers 1

IdentifierTypeStateIssuer
053337MedicaidAZ

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151030002303 AZ Practitioner - Urology 3870803059 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
Rush Medical College of Rush University, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Arizona Urology LLCGroup PAC ID 9537566930, 11 clinicians

Practice addresses (Care Compare)

13555 W McDowell Rd
Suite 302
Goodyear, AZ 85395-2629
Phone (623) 512-4390

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection1-10
Melanoma (skin cancer) excision1-10
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
50775AZMDUrology Physician
125-056789ILMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Yavapai Regional Medical Center Physician Care LLC CurrentSince Sep 11, 2023 Accepting new patients
Yavapai Regional Medical Center Physician Care LLC Current Accepting new patients
Yavapai Regional Medical Center Physician Care LLC CurrentSince Sep 11, 2023 Accepting new patients
Arizona Urology LLC Urology CurrentSince Oct 1, 2021 Accepting new patients

Locations

1488 W Elliot Rd
Gilbert, AZ 85233

1488 W Elliot Rd
Bldg 6
Gilbert, AZ 85233

17560 N 75th Ave
Ste 440
Glendale, AZ 85308
Phone (480) 526-5300

20325 N 51st Ave
Ste 170
Glendale, AZ 85308
Phone (623) 249-4928

13555 W McDowell Rd
Ste 302
Goodyear, AZ 85395

3815 E Bell Rd
Ste 4200
Phoenix, AZ 85032

3120 Clearwater Dr
Prescott, AZ 86305
Phone (928) 445-4818

Interoperability endpoints

  • Direct secure messaging: stephen.larsen.1@15230.direct.athenahealth.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 9

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": "1245888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484697600000",
    "number": "1215165584",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17560 N 75TH AVE",
            "address_2": "SUITE 440",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853085983",
            "telephone_number": "623-512-4390",
            "fax_number": "623-512-4139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13555 W MCDOWELL RD",
            "address_2": "302",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853952624",
            "telephone_number": "623-512-4390",
            "fax_number": "623-512-4391"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "STEPHEN",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-25",
        "last_updated": "2017-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "IL",
            "license": "125-056789",
            "primary": false
        },
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "AZ",
            "license": "50775",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "053337",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Goodyear, AZ

Sources for this page

Verify at the official NPI Registry.