NPIMap

Individual provider Active NPI

Sean Mark Larson, MD

  • Family Medicine Physician
  • Winston Salem, NC
National Provider Identifier
1518052471
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
2006-01541 Issued in NC
Practice address
4692 Brownsboro Rd
Winston Salem, NC 27106
Phone
(336) 251-1114
Fax
(336) 251-1117
NPI assigned
Oct 4, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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 2006-01541 NC Primary

Addresses

Primary practice location

4692 Brownsboro Rd
Winston Salem, NC 27106

Mailing address

4692 Brownsboro Rd
Winston Salem, NC 27106-3410
Phone (336) 251-1114

Other practice location 1

2890 S Lookout St
Claremont, NC 28610-9528
Phone (828) 459-7324

Other identifiers 2

IdentifierTypeStateIssuer
5906138MedicaidNC
1439POtherNCNC BCBS

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20070201000269 NC Practitioner - Family Practice 4385647593 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Minnesota, Duluth School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Physicians Eldercare PAGroup PAC ID 0648184705, 236 clinicians
Curana Health of North Carolina PLLCGroup PAC ID 1850774332, 274 clinicians

Practice addresses (Care Compare)

4692 Brownsboro Rd
Winston Salem, NC 27106-3410
Phone (336) 251-1114

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Physicians Eldercare PA CurrentSince Jan 2, 2019 Accepting new patients
Curana Health of North Carolina PLLC CurrentSince Sep 7, 2022 Accepting new patients
Catawba Valley Medical Center Past Accepting new patients
Catawba Valley Medical Center Past Accepting new patients
Everyage Past Accepting new patients

Locations

4692 Brownsboro Rd
Winston Salem, NC 27106
Phone (336) 251-1114

Interoperability endpoints

  • FHIR API: https://fhir.nextgen.com/nge/prod/fhir-api-r4/fhir/r4/

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Abernethy LaurelsNewton, NC, CCN 345161 Skilled nursing facility Adp of the SNF Jan 1, 2019

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 5

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 4

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": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1518052471",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4692 BROWNSBORO RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271063410",
            "telephone_number": "336-251-1114",
            "fax_number": "336-251-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4692 BROWNSBORO RD",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "27106",
            "telephone_number": "336-251-1114",
            "fax_number": "336-251-1117"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2890 S Lookout St",
            "address_purpose": "LOCATION",
            "city": "Claremont",
            "state": "NC",
            "postal_code": "286109528",
            "country_code": "US",
            "telephone_number": "828-459-7324",
            "fax_number": "828-459-7500",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LARSON",
        "first_name": "SEAN",
        "middle_name": "MARK",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-04",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NC",
            "license": "2006-01541",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5906138",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NC BCBS",
            "identifier": "1439P",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Winston Salem, NC

Sources for this page

Verify at the official NPI Registry.