Active NPI
Bruce D Larsen, M.D.
- Family Medicine Physician
- Farr West, UT
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 49625291205
- Practice address
- 2850 N 2000 W
Farr West, UT 84404-9219 - Phone
- (801) 377-5757
- NPI assigned
- Oct 18, 2006
- Last updated
- Jun 14, 2019
- 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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 49625291205 | UT | Primary |
Addresses
Primary practice location
2850 N 2000 W
Farr West, UT 84404-9219
Mailing address
1055 N 500 W
Attn: Credentialing
Provo, UT 84604
Phone (801) 354-8225
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
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Family Practice
- Education
- St. Louis College of Physicians and Surgeons, 2000
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
1055 N 500
Provo, UT 84604-3305
Phone (801) 429-8000
Hospital & facility affiliations
- Valeo Home Health
- Applegate Homecare
- Ogden Regional Medical Center
- Intermountain Health McKay-Dee Hospital
- Brigham City Community Hospital
- Holy Cross Hospital-Davis
- Bear River Valley Hospital
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
| Removal of skin lesions | 16 |
| Removal of nail tissue | 1-10 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 49625291205 | UT | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Revere Health PC | Current | Accepting new patients | |
| Revere Health PC | Current | Accepting new patients |
Locations
700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555
2850 N 2000 W
Ste 101
Ogden, UT 84404
Phone (801) 528-5095
1055 N 500 W
Provo, UT 84604
Phone (801) 429-8000
1055 N 500 W
Ste 212
Provo, UT 84604
Phone (801) 374-2362
Interoperability endpoints
- brucelarsen@cuccu.allscriptsdirect.net
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
Hospital & facility affiliations 7
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Home Health Agency
- Ogden, UT
- NPI 1649223256
-
dba Brigham City Community Hospital
- General Acute Care Hospital
- Brigham City, UT
- NPI 1245282227
-
dba Holy Cross Hospital - Davis
- General Acute Care Hospital
- Layton, UT
- NPI 1346945839
-
dba Ogden Regional Medical Center
- General Acute Care Hospital
- Ogden, UT
- NPI 1720031636
-
dba Intermountain Health McKay-Dee Hospital
- General Acute Care Hospital
- Ogden, UT
- NPI 1194749580
-
dba Intermountain Health Bear River Valley Hospital
- General Acute Care Hospital
- Tremonton, UT
- NPI 1679582944
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560470400000",
"number": "1922189372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1055 N 500 W",
"address_2": "ATTN: CREDENTIALING",
"city": "PROVO",
"state": "UT",
"postal_code": "84604",
"telephone_number": "801-354-8225",
"fax_number": "801-418-0941"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2850 N 2000 W",
"city": "FARR WEST",
"state": "UT",
"postal_code": "844049219",
"telephone_number": "801-377-5757"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSEN",
"first_name": "BRUCE",
"middle_name": "D",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-18",
"last_updated": "2019-06-14",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "UT",
"license": "49625291205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Farr West, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 14, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.