Amy Larsen, MD
Individual provider Active NPI Internal Medicine Physician · Saint Paul, MN
NPI 1720168537 · NPPES record last updated Mar 17, 2018
Key facts
- NPI
- 1720168537
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Internal Medicine Physician 207R00000X
- License
- 46577 (MN)
- Practice address
- 640 Jackson St
Saint Paul, MN 55101-2502 - Phone
- (651) 254-3456
- Fax
- (651) 254-9673
- NPI assigned
- Oct 16, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 18
Hospital & facility affiliations 8
Medicare Care Compare profile
- Specialty
- Internal Medicine
- Education
- Mayo Medical School, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Group Health Inc
Practice addresses (Care Compare)
2831 Snelling N Ave
Roseville, MN 55113-2460
Phone (651) 636-4525
640 Jackson St
Saint Paul, MN 55101-2502
Phone (651) 221-3456
8600 Nicollet Ave
Bloomington, MN 55420-2824
Phone (952) 884-1148
Hospital & facility affiliations
- Regions Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of nail tissue | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MN, WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050509000232 | MN | Practitioner - Internal Medicine | 0840230918 | Reassigns benefits to 3 organizations |
| I20121211000328 | WI | Practitioner - Internal Medicine |
0840230918 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46577 | MN | MD | Clinical Pathology/Laboratory Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Amery Regional Medical Center, Inc. | Current |
Accepting new patients | |
| Healthpartners RC | Current |
Accepting new patients | |
| Amery Regional Medical Center, Inc. | Current |
Accepting new patients | |
| Group Health, Inc. | Current | Accepting new patients | |
| Group Health, Inc. | Current |
Accepting new patients | |
| Amery Regional Medical Center, Inc. | Current |
Accepting new patients | |
| Group Health Plan, Inc. | Current |
Accepting new patients | |
| Healthpartners RC | Current |
Accepting new patients | |
| Regions Hospital | Past | Accepting new patients |
Locations
8170 33rd Ave S
#21110Q
Minneapolis, MN 55425
Phone (952) 883-5375
8600 Nicollet Ave S
Minneapolis, MN 55420
Phone (952) 887-6600
2220 Riverside Ave
Minneapolis, MN 55454
Phone (612) 371-1600
8170 33rd Ave S
Stop 21110Q
Minneapolis, MN 55425
100 Healthy Way
Olivia, MN 56277
Phone (320) 523-1261
640 Jackson St
Saint Paul, MN 55101
Phone (651) 221-2164
265 Griffin St E
Amery, WI 54001
Phone (715) 268-0301
405 Stageline Rd
Hudson, WI 54016
Phone (715) 531-6000
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Pathology/Laboratory Medicine Physician | 207ZP0105X | 46577 | MN | |
| Internal Medicine Physician | 207R00000X | 46577 | MN | Yes |
Addresses
Primary practice location
640 Jackson St
Saint Paul, MN 55101-2502
Mailing address
PO Box 1309
Ms 21110Q
Minneapolis, MN 55440-1309
Phone (651) 254-3456
Other practice location 1
210 9th St SE
Rochester, MN 55904-6756
Phone (507) 529-6616
Other practice location 2
210 9th St SE
Rochester, MN 55904-6756
Phone (507) 529-6616
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2368958 | Other | MN | AMERICA'S PPO |
| 505925 | Other | MN | FAIRVIEW |
| 04-00123 | Other | MN | MEDICA-PRIMARY |
| 34629900 | Medicaid | WI | |
| 0591149 | Medicaid | IA | |
| 1045965 | Other | PREFERRED ONE | |
| B539 | Other | CHAMPUS | |
| HP53301 | Other | MN | HEALTH PARTNERS |
| 0407540 | Other | MN | MEDICA-CHOICE |
| 132940 | Other | MN | UCARE |
| 631T3LA | Other | MN | BCBS |
| 622695700 | Medicaid | MN | |
| 9376963 | Other | MN | PHCS |
Other providers in Saint Paul, MN
- Roger R Laroche
- Lorraine Laroy
- Julian Andres Larrea Saavedra
- Larry Miller Chiropractic, Inc.
- Eryn Beth Larsen Smith
- Elizabeth L Larsen
- Michaela Anne Larsen
- Anne Louise Larson-Saunders
- Amy F Larson
- Andrea N Larson
All providers in Saint Paul, MN · Internal Medicine Physician in Minnesota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 17, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.