Madeline Rose Larsen, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

085009052 Issued in IL

Practice address

9650 Gross Point Rd Ste 2900
Skokie, IL 60076-5006

Phone

(847) 866-7846

Fax

(846) 954-5787

NPI assigned

Jun 9, 2022

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Endeavor Health Medical Group

  • Anesthesiology Physician
  • Evanston, IL
  • NPI 1265695944
  NPD

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

{
    "created_epoch": "1654732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1417686833",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9650 GROSS POINT RD STE 2900",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600765006",
            "telephone_number": "847-866-7846",
            "fax_number": "846-954-5787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9650 GROSS POINT RD STE 2900",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600765006",
            "telephone_number": "847-866-7846",
            "fax_number": "846-954-5787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "MADELINE",
        "middle_name": "ROSE",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-09",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085009052",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Laura Lange, L.C.S.W
• Kevin Lanham, LCPC
• Anna Lapinski
• Leah M Larkin Rivera, DDS
• Larryg Healthcare Services
• Anna Maria Lasota, NP-C
• Lasser Dermatology, LLC
• Alan Eugene Lasser, MD
• Joel Daniel Lathrop
• Catherine Lau, MA, CCC-SLP

• Surgical Physician Assistant in Skokie, IL
• Providers in Skokie, IL by specialty
• Surgical Physician Assistant in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2022; 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.