Individual provider Active NPI

Jessica Larson, MD

  • Pediatrics Physician
  • Elk River, MN
National Provider Identifier
1477595536
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
46376 Issued in MN
Practice address
290 Main St NW
Elk River, MN 55330-1270
Phone
(763) 241-5800
NPI assigned
Jun 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X 46376 MN Primary

Addresses

Primary practice location

290 Main St NW
Elk River, MN 55330-1270

Mailing address

27060 136TH St
Zimmerman, MN 55398-9300

Other names 1

  • Jessica Nicholson Former name

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050726000785 MN Practitioner - Pediatric Medicine 8224065750 Reassigns benefits to 2 organizations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Fairview Clinics CurrentSince Mar 17, 2012 Accepting new patients
Fairview Health Services CurrentSince Mar 17, 2012 Accepting new patients
Fairview Health Services Current Accepting new patients
Fairview Clinics Current Accepting new patients
Fairview Health Services Current Accepting new patients
Fairview Clinics CurrentSince Mar 13, 2020 Accepting new patients
Fairview Clinics CurrentSince Mar 13, 2020 Accepting new patients
Fairview Clinics Past Accepting new patients

Locations

1440 Duckwood Dr
Eagan, MN 55122
Phone (651) 406-8860

290 Main St NW
Elk River, MN 55330
Phone (763) 241-5800

290 Main St NW
Ste 100
Elk River, MN 55330
Phone (763) 241-0373

400 Stinson Blvd
Fl 2
Minneapolis, MN 55413
Phone (612) 672-2203

720 Washington Ave SE
Minneapolis, MN 55414
Phone (612) 883-0649

919 Northland Dr
Princeton, MN 55371
Phone (763) 389-3344

911 Northland Dr
Princeton, MN 55371
Phone (763) 389-1313

Interoperability endpoints

  • Direct secure messaging: jlarson8329@fairview.direct-ci.com

Organizations & group practices 9

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.

NPI Registry JSON

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

{
    "created_epoch": "1150070400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1477595536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27060 136TH ST",
            "city": "ZIMMERMAN",
            "state": "MN",
            "postal_code": "553989300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "290 MAIN ST NW",
            "city": "ELK RIVER",
            "state": "MN",
            "postal_code": "553301270",
            "telephone_number": "763-241-5800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "JESSICA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-12",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "MN",
            "license": "46376",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "NICHOLSON",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Elk River, MN

Sources for this page

Verify at the official NPI Registry.