Individual provider Active NPI

Sergiy Larin, MD

  • Anesthesiology Physician
  • Brookfield, WI
National Provider Identifier
1245750736
Registry record updated Nov 2, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
74292-20 Issued in WI
Practice address
19333 W North Ave
Brookfield, WI 53045-4132
Phone
(304) 293-1254
NPI assigned
Jun 26, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 2, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 29273 WV
Anesthesiology Physician 207L00000X 74292-20 WI Primary

Addresses

Primary practice location

19333 W North Ave
Brookfield, WI 53045-4132

Mailing address

19333 W North Ave
Brookfield, WI 53045-4132
Phone (262) 785-0409

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210503001742 WI Practitioner - Anesthesiology 2062787302 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
West Virginia University School of Medicine, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vituity-Wisconsin Anesthesia SCGroup PAC ID 2163968819, 144 clinicians

Practice addresses (Care Compare)

2301 N Lake Dr
Milwaukee, WI 53211-4508
Phone (414) 585-1132

Hospital & facility affiliations

  • Ascension SE Wisconsin Hospital Hospital, Milwaukee, WI, CCN 520136
  • Ascension Columbia St Marys Hospital Milwaukee Hospital, Milwaukee, WI, CCN 520051
  • Ascension St Francis Hospital Hospital, Milwaukee, WI, CCN 520078

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
29273WVMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vituity-Wisconsin Anesthesia SC Anesthesiology CurrentSince Oct 27, 2024 Accepting new patients
Vituity-Wisconsin Anesthesia SC Anesthesiology CurrentSince Oct 27, 2024 Accepting new patients

Locations

19333 W North Ave
Brookfield, WI 53045
Phone (262) 785-2000

2301 N Lake Dr
Milwaukee, WI 53211
Phone (414) 270-4932

5000 W Chambers St
Milwaukee, WI 53210
Phone (414) 447-2089

9555 76th St
Pleasant Prairie, WI 53158
Phone (262) 577-8000

13111 N Port Washington Rd
Thiensville, WI 53097
Phone (262) 243-7300

201 N Mayfair Rd
Fl 2
Wauwatosa, WI 53226
Phone (414) 771-8228

Organizations & group practices 3

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

Hospital & facility affiliations 4

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": "1498435200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1635811200000",
    "number": "1245750736",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19333 W NORTH AVE",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530454132",
            "telephone_number": "262-785-0409",
            "fax_number": "954-851-1746"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19333 W NORTH AVE",
            "city": "BROOKFIELD",
            "state": "WI",
            "postal_code": "530454132",
            "telephone_number": "304-293-1254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARIN",
        "first_name": "SERGIY",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-26",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WV",
            "license": "29273",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WI",
            "license": "74292-20",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brookfield, WI

Sources for this page

Verify at the official NPI Registry.