NPIMap

Individual provider Active NPI

Jon D Larson, MD

  • Family Medicine Physician
  • Detroit Lakes, MN
National Provider Identifier
1508884172
Registry record updated Apr 21, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
45023 Issued in MN
Practice address
1245 Washington Ave
Detroit Lakes, MN 56501-3905
Phone
(218) 846-2000
Fax
(218) 846-2114
NPI assigned
Jul 18, 2006
Last updated
Apr 21, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 45023 MN Primary

Addresses

Primary practice location

1245 Washington Ave
Detroit Lakes, MN 56501-3905

Mailing address

PO Box 5074
Sioux Falls, SD 57117-5074

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jlarson1840861@direct.sanfordhealth.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MN, ND2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20040601001446 MN Practitioner - Family Practice 1355323635 Reassigns benefits to 3 organizations
I20180206000770 ND Practitioner - Family Practice 1355323635 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of North Dakota School of Medicine, 1991
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sanford Medical Center FargoGroup PAC ID 8426967803, 1,210 clinicians
Sanford Clinic NorthGroup PAC ID 4284546151, 9 clinicians

Practice addresses (Care Compare)

1220 Sheyenne St
West Fargo, ND 58078-2637
Phone (701) 234-4445

1245 Washington Ave
Detroit Lakes, MN 56501-3905
Phone (218) 846-2000

1412 Main St
Hawley, MN 56549
Phone (218) 483-3564

211 E Mill St
Pelican Rapids, MN 56572-4234
Phone (218) 863-6100

2400 32ND Ave S
Fargo, ND 58103-5800
Phone (701) 234-2000

410 4TH St NW
Mahnomen, MN 56557-4208
Phone (218) 935-2514

410 4TH St SW
Mahnomen, MN 56557-4732
Phone (218) 835-2514

4840 23Rd Ave S
Fargo, ND 58104-9136
Phone (701) 417-6999

800 Broadway N
Fargo, ND 58102-3641

801 Broadway N
Fargo, ND 58102-3641
Phone (701) 234-2000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.99 of 100Reported as group
Quality
92.39
Promoting interoperability
100
Improvement activities
40
Cost
70.9

Merit-based Incentive Payment System (MIPS)

Final score
82.73 of 100Reported as group
Quality
71.75
Promoting interoperability
100
Improvement activities
40
Cost
70.68

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy1-10
Removal of skin lesions1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
45023MNMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Sanford Medical Center Fargo Family Medicine CurrentSince Dec 23, 2017 Accepting new patients
Sanford Health of Northern Minnesota CurrentSince Jun 2, 2013 Accepting new patients
Sanford Medical Center Fargo CurrentSince Dec 23, 2017 Accepting new patients
Sanford Medical Center Fargo Family Medicine CurrentSince Jul 8, 2022 Accepting new patients
Sanford Health of Northern Minnesota Family Medicine Current Accepting new patients
Sanford Health of Northern Minnesota Family Medicine CurrentSince Jun 2, 2013 Accepting new patients
St. Marys Regional Health Center Past Accepting new patients
Mahnomen Health Center Past Accepting new patients
Sanford Medical Center Fargo Past Accepting new patients

Locations

1611 Anne St NW
Bemidji, MN 56601
Phone (218) 333-2020

1027 Washington Ave
Detroit Lakes, MN 56501
Phone (218) 844-2300

1245 Washington Ave
Detroit Lakes, MN 56501
Phone (218) 846-2000

414 W Jefferson Ave
Mahnomen, MN 56557
Phone (218) 935-2511

4000 28th Ave S
Moorhead, MN 56560
Phone (701) 234-3200

211 E Mill St
Pelican Rapids, MN 56572
Phone (218) 863-6100

2400 32nd Ave S
Fargo, ND 58103
Phone (701) 234-8800

801 Broadway N
Fargo, ND 58102
Phone (701) 234-2371

1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445

Organizations & group practices 11

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

Hospital & facility affiliations 13

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 13

NPI Registry JSON

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

{
    "created_epoch": "1153180800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745193600000",
    "number": "1508884172",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5074",
            "city": "SIOUX FALLS",
            "state": "SD",
            "postal_code": "571175074"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1245 WASHINGTON AVE",
            "city": "DETROIT LAKES",
            "state": "MN",
            "postal_code": "565013905",
            "telephone_number": "218-846-2000",
            "fax_number": "218-846-2114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "JON",
        "middle_name": "D",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-18",
        "last_updated": "2025-04-21",
        "certification_date": "2025-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "45023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jlarson1840861@direct.sanfordhealth.org",
            "affiliation": "N",
            "address_1": "1245 Washington Ave",
            "city": "Detroit Lakes",
            "state": "MN",
            "country_code": "US",
            "postal_code": "565013905",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Detroit Lakes, MN

Sources for this page

Verify at the official NPI Registry.