Individual provider Active NPI

Andrew Stuart Larson, DO

  • Student in an Organized Health Care Education/Training Program
  • Mount Vernon, WA
National Provider Identifier
1700635109
Registry record updated May 16, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X
Practice address
819 S 13TH St
Mount Vernon, WA 98274-4112
Phone
(636) 489-9713
NPI assigned
May 16, 2024
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 16, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X Primary

Addresses

Primary practice location

819 S 13TH St
Mount Vernon, WA 98274-4112

Mailing address

6890 S Maverick Cir
Cottonwood Heights, UT 84121-3302
Phone (636) 489-9713

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240722002017 WA Order and Referring Only - Family PracticePractitioner - Family Practice 4284170663

National Provider Directory

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

Interoperability endpoints

  • Direct secure messaging: alarson47072@skagit.direct-ci.com

NPI Registry JSON

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

{
    "created_epoch": "1715817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715817600000",
    "number": "1700635109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6890 S MAVERICK CIR",
            "city": "COTTONWOOD HEIGHTS",
            "state": "UT",
            "postal_code": "841213302",
            "telephone_number": "636-489-9713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "819 S 13TH ST",
            "city": "MOUNT VERNON",
            "state": "WA",
            "postal_code": "982744112",
            "telephone_number": "636-489-9713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "ANDREW",
        "middle_name": "STUART",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-05-16",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Mount Vernon, WA

Sources for this page

Verify at the official NPI Registry.