Dallen J Larson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

3322321206 Issued in UT

Practice address

4650 Harrison Blvd
Ogden, UT 84403-4303

Phone

(801) 475-3021

Fax

(801) 475-3031

NPI assigned

Oct 17, 2005

Last updated

Jan 17, 2017By the provider in NPPES

Sex

Male

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

Enrolled in UT

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ogden Clinic PCGroup PAC ID 9638078033, 104 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/DGHAED/Endpoint/DGHAED
• FHIR API: https://fhir4.healow.com/fhir/r4/JJJGBA

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.

• Ogden Clinic PC

  • Family Medicine Physician
  • Ogden, UT
  • NPI 1578550083
  Medicare reassignment Care Compare group
• Jordan Ridge Family Medicine LLC

  • Family Medicine Physician
  • Salt Lake City, UT
  • NPI 1770509754
  Medicare reassignment NPD (past)
• Jordan Ridge Family Medicine LLC

  • Primary Care Clinic/Center
  • Sandy, UT
  • NPI 1962166710
  NPD
• Ogden Clinic Specialty Services LLC

  dba Ogden Clinic PC

  • Sports Medicine (Family Medicine) Physician
  • Ogden, UT
  • NPI 1114203668

  Physician Assistant

  NPD

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

{
    "created_epoch": "1129507200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1484611200000",
    "number": "1609865203",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5546",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802175546",
            "telephone_number": "801-475-3021",
            "fax_number": "801-475-3031"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4650 HARRISON BLVD",
            "city": "OGDEN",
            "state": "UT",
            "postal_code": "844034303",
            "telephone_number": "801-475-3021",
            "fax_number": "801-475-3031"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "DALLEN",
        "middle_name": "J",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-17",
        "last_updated": "2017-01-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "3322321206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Raeshelle Jane Larsen, RN
• Ryan Scott Larsen, NP
• Scott Rex Larsen, MD
• Tyler Kent Larsen
• Alexander J Larson, MD
• Heather D Larson, PA-C
• Russell Larson
• Noah Jay Lattin
• Alfred Liat-Khoon Lau, M.A.
• Isabel Cristina Lau, MD

• Physician Assistant in Ogden, UT
• Providers in Ogden, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2017; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.