Active NPI
Mitchell D Larson, CRNA
- Certified Registered Nurse Anesthetist
- Greeley, CO
National Provider Identifier
1639147705
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Certified Registered Nurse Anesthetist
- License
- CRA-15015
- Practice address
- 1801 16TH St
Greeley, CO 80631-5154 - Phone
- (970) 352-4121
- NPI assigned
- Mar 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Certified Registered Nurse Anesthetist | 367500000X | 1378618 | MN | |
| Certified Registered Nurse Anesthetist | 367500000X | CRA-15015 | CO | Primary |
Addresses
Primary practice location
1801 16TH St
Greeley, CO 80631-5154
Mailing address
6527 Aberdour Cir
Windsor, CO 80550-7012
Phone (970) 776-6991
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 122019500 | Medicaid | MN | |
| 16674847 | Medicaid | CO |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CO, WY
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Certified Registered Nurse Anesthetist (Crna)
- Education
- Other, 1997
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1801 16TH St
Greeley, CO 80631-5154
Phone (970) 810-4121
Hospital & facility affiliations
- Banner North Colorado Medical Center
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CRA-15015 | CO | MD | Certified Registered Nurse Anesthetist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Rocky Mountain State Anesthesia Providers | Current | Accepting new patients | |
| Sterling Anesthesia Associates LLC | Nurse Anesthetist, Certified Registered | Current | Accepting new patients |
| Rocky Mountain State Anesthesia Providers | Current | Accepting new patients | |
| Dakota Surgery & Laser Center LLC | Past | Accepting new patients |
Locations
4700 Lady Moon Dr
Fort Collins, CO 80528
Phone (970) 521-4600
5890 W 13th St
Greeley, CO 80634
Phone (970) 356-4567
1801 16th St
Greeley, CO 80631
Phone (970) 352-4121
1801 16th St
Ste C2B
Greeley, CO 80631
Phone (970) 810-4121
5890 W 13th St
Ste 102
Greeley, CO 80634
Phone (970) 348-0090
2000 Boise Ave
Loveland, CO 80538
Phone (970) 635-4071
615 Fairhurst St
Sterling, CO 80751
Phone (970) 521-0322
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.
-
- Anesthesiology Physician
- Greeley, CO
- NPI 1730692054
-
- Anesthesiology Physician
- Sterling, CO
- NPI 1932978897
Nurse Anesthetist, Certified Registered
-
- Critical Access Hospital
- Torrington, WY
- NPI 1669410643
-
- Anesthesiology Physician
- Loveland, CO
- NPI 1710510417
-
- Ambulatory Surgical Clinic/Center
- Bismarck, ND
- NPI 1952348013
Hospital & facility affiliations 12
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Loveland, CO
- NPI 1174231682
-
- Critical Access Hospital
- Greeley, CO
- NPI 1255971404
-
- General Acute Care Hospital
- Greeley, CO
- NPI 1477376986
-
- Special Hospital
- Loveland, CO
- NPI 1487535431
-
- Critical Access Hospital
- Greeley, CO
- NPI 1578103750
-
- General Acute Care Hospital
- Greeley, CO
- NPI 1720004450
-
- Critical Access Hospital
- Greeley, CO
- NPI 1831739267
-
- General Acute Care Hospital
- Greeley, CO
- NPI 1962103622
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1142294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1277251200000",
"number": "1639147705",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6527 ABERDOUR CIR",
"city": "WINDSOR",
"state": "CO",
"postal_code": "805507012",
"telephone_number": "970-776-6991"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1801 16TH ST",
"city": "GREELEY",
"state": "CO",
"postal_code": "806315154",
"telephone_number": "970-352-4121"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "MITCHELL",
"middle_name": "D",
"credential": "CRNA",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-03-14",
"last_updated": "2010-06-23",
"status": "A"
},
"taxonomies": [
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "MN",
"license": "1378618",
"primary": false
},
{
"code": "367500000X",
"taxonomy_group": "",
"desc": "Nurse Anesthetist, Certified Registered",
"state": "CO",
"license": "CRA-15015",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "122019500",
"state": "MN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "16674847",
"state": "CO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Greeley, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- 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.