Active NPI
Kenneth W. Larson, MD
- Surgery Physician
- Springfield, MO
National Provider Identifier
1689741795
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Surgery Physician
- License
- 105284
- Practice address
- 1900 S National Ave
Suite 1950
Springfield, MO 65804-2265 - Phone
- (417) 820-7250
- Fax
- (417) 820-7255
- NPI assigned
- Nov 30, 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 |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 105284 | MO | Primary |
| Trauma Surgery Physician | 2086S0127X | 105284 | MO |
Addresses
Primary practice location
1900 S National Ave
Suite 1950
Springfield, MO 65804-2265
Mailing address
PO Box 2580
Springfield, MO 65801-2580
Phone (417) 829-4620
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 207672502 | Medicaid | MO | |
| 431560263 | Other | MO | TRICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- General Surgery
- Education
- University of Missouri, Columbia School of Medicine, 1989
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
Practice addresses (Care Compare)
1965 S Fremont Ave
230 MC General and Trauma Surgery
Springfield, MO 65804-2258
Phone (417) 820-7250
Hospital & facility affiliations
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Hernia repair - groin (open) | 1-10 |
| Removal of tissue | 12 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mercy Clinic Springfield Communities | Current | Accepting new patients | |
| Mercy Clinic Springfield Communities | Current | Accepting new patients | |
| Ozarks Medical Center | Past | Accepting new patients | |
| Mercy Hospital Springfield | Past | Accepting new patients |
Locations
1605 Martin Springs Dr
Ste 330
Rolla, MO 65401
Phone (573) 458-6379
620 S Glenstone Ave
Springfield, MO 65802
Phone (417) 829-4215
1965 S Fremont Ave
Ste 230
Springfield, MO 65804
Phone (417) 820-3809
2115 S Fremont Ave
Ste 3050
Springfield, MO 65804
Phone (417) 820-3905
1235 E Cherokee St
Springfield, MO 65804
Phone (417) 820-2115
Interoperability endpoints
- klarson18441@directc.mercy.net
- klarson918@directb.mercy.net
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.
-
- Family Medicine Physician
- Springfield, MO
- NPI 1245277631
-
- Rural Health Clinic/Center
- Willow Springs, MO
- NPI 1972771657
-
- General Acute Care Hospital
- Springfield, MO
- NPI 1578504056
-
- General Acute Care Hospital
- West Plains, MO
- NPI 1831115641
Hospital & facility affiliations 10
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- General Acute Care Hospital
- Springfield, MO
- NPI 1578504056
-
- Critical Access Hospital
- Mountain View, MO
- NPI 1023053477
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164844800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1367452800000",
"number": "1689741795",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 2580",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658012580",
"telephone_number": "417-829-4620"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 S NATIONAL AVE",
"address_2": "SUITE 1950",
"city": "SPRINGFIELD",
"state": "MO",
"postal_code": "658042265",
"telephone_number": "417-820-7250",
"fax_number": "417-820-7255"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "KENNETH",
"middle_name": "W.",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-11-30",
"last_updated": "2013-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "MO",
"license": "105284",
"primary": true
},
{
"code": "2086S0127X",
"taxonomy_group": "",
"desc": "Surgery, Trauma Surgery",
"state": "MO",
"license": "105284",
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "207672502",
"state": "MO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "431560263",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Springfield, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2013; 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.