Individual provider Active NPI

Peter G Larcom, MD

  • Adult Reconstructive Orthopaedic Surgery Physician
  • Murray, UT
National Provider Identifier
1821029869
Registry record updated Jan 3, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Reconstructive Orthopaedic Surgery PhysicianTaxonomy code 207XS0114X
License
321930-1205 Issued in UT
Practice address
5316 S Woodrow St Ste 200
Murray, UT 84107-5838
Phone
(801) 747-1020
Fax
(801) 747-1023
NPI assigned
Jul 6, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 3, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Reconstructive Orthopaedic Surgery Physician 207XS0114X 321930-1205 UT Primary

Addresses

Primary practice location

5316 S Woodrow St Ste 200
Murray, UT 84107-5838

Mailing address

5316 S Woodrow St Ste 200
Murray, UT 84107-5838
Phone (801) 747-1020

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT
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
I20040818000346 UT Practitioner - Orthopedic Surgery 3274506118 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Orthopedic Surgery
Education
Tufts University School of Medicine, 1989
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

5121 S Cottonwood St
Murray, UT 84107-5701

5316 S Woodrow St
Suite 200
Murray, UT 84107-5479
Phone (801) 747-1020

8 TH Ave and C St
LDS Hosp Eeg Phys GRP
Salt Lake City, UT 84143
Phone (801) 507-7000

Hospital & facility affiliations

  • Intermountain Homecare Home Health Salt Lake Home health agency, South Jordan, UT, CCN 467030
  • Intermountain Medical Center Hospital, Murray, UT, CCN 460010
  • St Mark'S Hospital Hospital, Salt Lake City, UT, CCN 460047

Procedures performed for Medicare patients

ProcedureNumber of procedures
Hip replacement1-10
Knee replacement1-10
Upper limb (arm) arthroscopy (minimally invasive joint repair)1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
321930-1205UTMDAdult Reconstructive Orthopaedic Surgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Ihc Health Services Inc CurrentSince Nov 3, 2005 Accepting new patients
Ihc Health Services, Inc. CurrentSince Nov 3, 2005 Accepting new patients
Peter G. Larcom MD PC Adult Reconstructive Orthopaedic Surgery CurrentSince Oct 1, 2000 Accepting new patients
Ihc Health Services Inc Current Accepting new patients

Locations

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

5316 S Woodrow St
Ste 200
Salt Lake City, UT 84107
Phone (801) 747-1020

5121 S Cottonwood St
Salt Lake Cty, UT 84107
Phone (801) 408-8998

400 C St
Salt Lake Cty, UT 84143
Phone (435) 688-4080

440 D St
#206
Slc, UT 84103
Phone (801) 408-2900

Interoperability endpoints

  • Direct secure messaging: peter.larcom.1@30853.direct.athenahealth.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 3

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": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1546473600000",
    "number": "1821029869",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5316 S WOODROW ST STE 200",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841075838",
            "telephone_number": "801-747-1020",
            "fax_number": "801-747-1023"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5316 S WOODROW ST STE 200",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841075838",
            "telephone_number": "801-747-1020",
            "fax_number": "801-747-1023"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARCOM",
        "first_name": "PETER",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-06",
        "last_updated": "2019-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207XS0114X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Adult Reconstructive Orthopaedic Surgery",
            "state": "UT",
            "license": "321930-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Murray, UT

Sources for this page

Verify at the official NPI Registry.