Individual provider Active NPI

Timothy C Larsen, M.D.

  • Anesthesiology Physician
  • Appleton, WI
National Provider Identifier
1760417760
Registry record updated Jul 9, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
45036-20 Issued in WI
Practice address
1818 N Meade St
Appleton, WI 54911-3454
Phone
(920) 731-4101
NPI assigned
Jul 11, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 9, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 45036-20 WI Primary

Addresses

Primary practice location

1818 N Meade St
Appleton, WI 54911-3454

Mailing address

200 E Washington St
P O Box 8031
Appleton, WI 54911-5490
Phone (800) 261-1770

Other identifiers 1

IdentifierTypeStateIssuer
34388900MedicaidWI

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20050810001094 WI Practitioner - Anesthesiology 6406885367 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
University of Wisconsin School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Association of Hospital Anesthesiologists SCGroup PAC ID 3476539875, 84 clinicians

Practice addresses (Care Compare)

100 County Rd B
Shawano, WI 54166-7072
Phone (715) 526-2111

1818 N Meade St
Appleton, WI 54911-3454
Phone (920) 731-4101

2500 E Capital Dr
Appleton, WI 54911-8735
Phone (920) 738-6400

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
45036-20WIMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Association of Hospital Anesthesiologists SC Anesthesiology CurrentSince Jan 1, 2014 Accepting new patients
Nurse Anesthesia Professional Services LLC PastSince Dec 15, 2024 Accepting new patients

Locations

2325 N Casaloma Dr
Appleton, WI 54913
Phone (920) 225-8030

1818 N Meade St
Appleton, WI 54911
Phone (920) 731-4101

736 Ford St
Kimberly, WI 54136

130 2nd St
#A107
Neenah, WI 54956

130 2nd St
Neenah, WI 54956
Phone (920) 729-2063

Organizations & group practices 2

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 7

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": "1152576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1760417760",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E WASHINGTON ST",
            "address_2": "P O BOX 8031",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549115490",
            "telephone_number": "800-261-1770",
            "fax_number": "920-739-0124"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1818 N MEADE ST",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549113454",
            "telephone_number": "920-731-4101"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "TIMOTHY",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-11",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "WI",
            "license": "45036-20",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34388900",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.