Amy S Larson, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

036106772 Issued in IL

Practice address

834 N Seminary St
Suite 304
Galesburg, IL 61401-2852

Phone

(309) 342-2144

Fax

(309) 342-5104

NPI assigned

Sep 26, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Other names 1

• Amy S. Fleisher Former name

Medicare fee-for-service enrollment

Enrolled in IL

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: alarsonm@yourcarecommunity.org

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.

• Osf Multi-Specialty Group

  • Internal Medicine Physician
  • Peoria, IL
  • NPI 1922445527
  Medicare reassignment NPD
• St Mary Medical Center

  • Emergency Medical Services (Emergency Medicine) Physician
  • Galesburg, IL
  • NPI 1962467670
  Medicare reassignment NPD
• St Mary Medical Center

  • Rural Health Clinic/Center
  • Galesburg, IL
  • NPI 1275234965
  NPD
• St. Mary Medical Center

  • Family Medicine Physician
  • Abingdon, IL
  • NPI 1861109647
  NPD
• Central PA Pharmacy LLC.

  • Community/Retail Pharmacy
  • Patton, PA
  • NPI 1578541413
  NPD
• Galesburg Clinic PC

  • Specialist
  • Galesburg, IL
  • NPI 1972614808
  NPD (past)
• St Mary Medical Center

  • General Acute Care Hospital
  • Galesburg, IL
  • NPI 1164485363
  NPD (past)
• St Mary Medical Center

  • Family Medicine Physician
  • Galesburg, IL
  • NPI 1457308710

  Pediatrics

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1329436800000",
    "number": "1356442172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "834 N SEMINARY ST",
            "address_2": "SUITE 304",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614012852",
            "telephone_number": "309-342-2144",
            "fax_number": "309-342-5104"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "834 N SEMINARY ST",
            "address_2": "SUITE 304",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614012852",
            "telephone_number": "309-342-2144",
            "fax_number": "309-342-5104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "AMY",
        "middle_name": "S",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-09-26",
        "last_updated": "2012-02-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "IL",
            "license": "036106772",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036106772",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC/BS",
            "identifier": "4815127",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7860434",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11053882",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "JOHN DEERE",
            "identifier": "364271985-28",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "AMY",
            "last_name": "FLEISHER",
            "middle_name": "S.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Ladner and Jain Orthodontics, LLP
• Paul T. Ladner, D.D.S., M.S.
• Shannon Michelle Lampson, R.N.
• Laurali N Lape, LPN
• Michael L Larsen, DC
• Kristin Larson, ED.D.
• Susan Latta, OT
• Valerie Lawson
• Linda Kathleen Leafgreen, R.N.
• Jennifer Ann Lee, LCSW

• Pediatrics Physician in Galesburg, IL
• Providers in Galesburg, IL by specialty
• Pediatrics Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 17, 2012; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.