NPIMap

Individual provider Active NPI

David C Larsen, MD

  • Family Medicine Physician
  • Salt Lake City, UT
National Provider Identifier
1679548564
Registry record updated May 10, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
30852741205 Issued in UT
Practice address
999 Murray Holladay Rd
Suite 207
Salt Lake City, UT 84117-4901
Phone
(801) 268-2584
Fax
(801) 262-1168
NPI assigned
Feb 22, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 10, 2011

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 30852741205 UT Primary

Addresses

Primary practice location

999 Murray Holladay Rd
Suite 207
Salt Lake City, UT 84117-4901

Mailing address

999 Murray Holladay Rd
Suite 207
Salt Lake City, UT 84117-4901
Phone (801) 268-2584

Other identifiers 1

IdentifierTypeStateIssuer
870573947004MedicaidUT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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
I20040304001080 UT Practitioner - Family Practice 6709774540 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
University of Utah School of Medicine, 1997
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Granger Medical Clinic PCGroup PAC ID 3476465691, 192 clinicians

Practice addresses (Care Compare)

2965 W 3500
West Valley City, UT 84119-3602
Phone (801) 965-3600

Hospital & facility affiliations

  • True North Home Health Home health agency, South Salt Lake, UT, CCN 467224
  • Intermountain Medical Center Hospital, Murray, UT, CCN 460010
  • St Mark'S Hospital Hospital, Salt Lake City, UT, CCN 460047
  • Intermountain Health Alta View Hospital Hospital, Sandy, UT, CCN 460044

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
30852741205UTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Granger Medical Clinic, Inc. CurrentSince Dec 26, 2023 Accepting new patients
Granger Medical Clinic PC Family Medicine Current Accepting new patients
Granger Medical Specialists LLC CurrentSince Oct 9, 2023 Accepting new patients
Granger Medical Specialists, LLC CurrentSince Oct 9, 2023 Accepting new patients

Locations

12391 S 4000 W
Riverton, UT 84096
Phone (801) 302-1700

995 W Levoy Dr
Taylorsville, UT 84123

7181 S Campus View Dr
West Jordan, UT 84084
Phone (801) 965-3505

3725 W 4100 S
West Valley City, UT 84120
Phone (801) 965-3545

2965 W 3500 S
West Valley City, UT 84119
Phone (801) 965-3505

Interoperability endpoints

  • Direct secure messaging: david.larsen@gmcwv.eclinicaldirectplus.com

Organizations & group practices 4

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": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1304985600000",
    "number": "1679548564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "999 MURRAY HOLLADAY RD",
            "address_2": "SUITE 207",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841174901",
            "telephone_number": "801-268-2584",
            "fax_number": "801-262-1168"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "999 MURRAY HOLLADAY RD",
            "address_2": "SUITE 207",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841174901",
            "telephone_number": "801-268-2584",
            "fax_number": "801-262-1168"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "DAVID",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2011-05-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "30852741205",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "870573947004",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Salt Lake City, UT

Sources for this page

Verify at the official NPI Registry.