Active NPI
Jerry K Larsen, MD PC
- Psychiatry Physician
- Oregon City, OR
National Provider Identifier
1861546673
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- MD07904
- Practice address
- 610 Jefferson St
Willamette Valley Family Center
Oregon City, OR 97045 - Phone
- (503) 657-7235
- Fax
- (503) 657-7676
- NPI assigned
- Jan 22, 2007
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | MD07904 | OR | Primary |
Addresses
Primary practice location
610 Jefferson St
Willamette Valley Family Center
Oregon City, OR 97045
Mailing address
15255 SE River Forest Dr
Milwaukie, OR 97267
Phone (503) 657-7235
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Willamette Valley Family Center | Psychiatry | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169424000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1861546673",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15255 SE RIVER FOREST DR",
"city": "MILWAUKIE",
"state": "OR",
"postal_code": "97267",
"telephone_number": "503-657-7235",
"fax_number": "503-657-7676"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 JEFFERSON ST",
"address_2": "WILLAMETTE VALLEY FAMILY CENTER",
"city": "OREGON CITY",
"state": "OR",
"postal_code": "97045",
"telephone_number": "503-657-7235",
"fax_number": "503-657-7676"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSEN",
"first_name": "JERRY",
"middle_name": "K",
"credential": "MD PC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "OR",
"license": "MD07904",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oregon City, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.