Active NPI
Leesa Rae Novotny, MD
- Family Medicine Physician
- Montevideo, MN
National Provider Identifier
1225483563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 64617
- Practice address
- 824 N 11TH St
Montevideo, MN 56265 - Phone
- (320) 269-8877
- Fax
- (320) 269-8186
- NPI assigned
- Apr 24, 2016
- Last updated
- Dec 29, 2021
- Sex
- Female
- Sole proprietor
- Yes
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 | 64617 | MN | Primary |
Addresses
Primary practice location
824 N 11TH St
Montevideo, MN 56265
Mailing address
824 N 11TH St
Montevideo, MN 56265
Phone (320) 269-8877
Other practice location 1
1304 E Lincoln Ave
Montevideo, MN 56265-2019
Phone (320) 339-2199
Other names 1
- Leesa Rae Larson
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | llarson298384@direct.centracare.com |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- Other, 2015
- Medicare assignment
- May accept Medicare assignment
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
824 N 11TH St
Montevideo, MN 56265-1629
Phone (320) 269-8877
Hospital & facility affiliations
Merit-based Incentive Payment System (MIPS)
- Final score
- 89.17 of 100
- Quality
- 96.66
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 67.25
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| CCM Health | Current | Accepting new patients | |
| CCM Health | Current | Accepting new patients | |
| CCM Health | Past | Accepting new patients | |
| Clarkfield Care Center | Past | Accepting new patients |
Locations
824 N 11th St
Montevideo, MN 56265
Phone (320) 269-8877
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.
-
- Critical Access Hospital
- Montevideo, MN
- NPI 1720086028
-
- Rural Health Clinic/Center
- Milan, MN
- NPI 1457132466
-
- Rural Health Clinic/Center
- Montevideo, MN
- NPI 1407636475
-
- Skilled Nursing Facility
- Clarkfield, MN
- NPI 1548291404
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
dba Chippewa County Montevideo Hospital Urgent Care
- Urgent Care Clinic/Center
- Montevideo, MN
- NPI 1275057978
Hospital
-
- Critical Access Hospital
- Montevideo, MN
- NPI 1720086028
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1461456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1640736000000",
"number": "1225483563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "824 N 11TH ST",
"city": "MONTEVIDEO",
"state": "MN",
"postal_code": "56265",
"telephone_number": "320-269-8877",
"fax_number": "320-269-8186"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "824 N 11TH ST",
"city": "MONTEVIDEO",
"state": "MN",
"postal_code": "56265",
"telephone_number": "320-269-8877",
"fax_number": "320-269-8186"
}
],
"practiceLocations": [
{
"address_1": "1304 E Lincoln Ave",
"address_purpose": "LOCATION",
"city": "Montevideo",
"state": "MN",
"postal_code": "562652019",
"country_code": "US",
"telephone_number": "320-339-2199",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NOVOTNY",
"first_name": "LEESA",
"middle_name": "RAE",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-04-24",
"last_updated": "2021-12-29",
"certification_date": "2021-12-29",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "MN",
"license": "64617",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "llarson298384@direct.centracare.com",
"affiliation": "N",
"address_1": "824 N 11th St",
"city": "Montevideo",
"state": "MN",
"country_code": "US",
"postal_code": "56265",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": [
{
"first_name": "LEESA",
"last_name": "LARSON",
"middle_name": "RAE",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Montevideo, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.