Individual provider Active NPI

Timothy Raymond Larsen, D.O.

  • Clinical Cardiac Electrophysiology Physician
  • Chicago, IL
National Provider Identifier
1477845337
Registry record updated Jul 23, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X
License
036-149085 Issued in IL
Practice address
1725 W Harrison St Ste 1159
Chicago, IL 60612
Phone
(312) 942-5020
NPI assigned
May 11, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 23, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X 036-149085 IL
Clinical Cardiac Electrophysiology Physician 207RC0001X 036-149085 IL Primary

Addresses

Primary practice location

1725 W Harrison St Ste 1159
Chicago, IL 60612

Mailing address

1725 W Harrison St Ste 1159
Chicago, IL 60612-3883
Phone (312) 942-5020

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20190730000624 IL Practitioner - Cardiac Electrophysiology 4284854159 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiac Electrophysiology
Education
Michigan State University College of Osteopathic Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Rush University Medical GroupGroup PAC ID 5496658874, 1,521 clinicians

Practice addresses (Care Compare)

1411 S Michigan Ave
Chicago, IL 60605-2810
Phone (312) 454-2700

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Pacemaker insertion or repair28
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-149085ILMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Rush University Medical Group CurrentSince Aug 1, 2019 Accepting new patients

Locations

1725 W Harrison St
Ste 358
Chicago, IL 60612
Phone (312) 563-5020

1411 S Michigan Ave
Chicago, IL 60605
Phone (312) 454-2700

1700 W Van Buren St
#500
Chicago, IL 60612
Phone (312) 563-2875

1725 W Harrison St
Ste 1010
Chicago, IL 60612
Phone (312) 942-5904

2525 S Michigan Ave
Chicago, IL 60616
Phone (312) 355-1153

1725 W Harrison St
Ste 1159
Chicago, IL 60612
Phone (312) 942-5020

75 Remittance Dr
Dept 1611
Chicago, IL 60675

1625 N Harlem Ave
Chicago, IL 60707
Phone (312) 256-8583

Interoperability endpoints

  • Direct secure messaging: tlarsen155392@direct.rush.rush-health.com

Organizations & group practices 1

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 7

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": "1305072000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563840000000",
    "number": "1477845337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1725 W HARRISON ST STE 1159",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606123883",
            "telephone_number": "312-942-5020"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1725 W HARRISON ST STE 1159",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "60612",
            "telephone_number": "312-942-5020"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "TIMOTHY",
        "middle_name": "RAYMOND",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-05-11",
        "last_updated": "2019-07-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "IL",
            "license": "036-149085",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "IL",
            "license": "036-149085",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Chicago, IL

Sources for this page

Verify at the official NPI Registry.