Bruce D Larsen, M.D.
Individual provider Active NPI Family Medicine Physician · Farr West, UT
NPI 1922189372 · NPPES record last updated Jun 14, 2019
Key facts
- NPI
- 1922189372
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 49625291205 (UT)
- Practice address
- 2850 N 2000 W
Farr West, UT 84404-9219 - Phone
- (801) 377-5757
- NPI assigned
- Oct 18, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 6
Hospital & facility affiliations 7
Medicare Care Compare profile
- 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
- Revere Health PC
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 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in UT
- 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 |
|---|---|---|---|---|
| I20040730000244 | UT | Practitioner - Family Practice | 2769452275 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- 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
Ste 212
Provo, UT 84604
Phone (801) 374-2362
1055 N 500 W
Provo, UT 84604
Phone (801) 429-8000
Interoperability endpoints
- brucelarsen@cuccu.allscriptsdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 49625291205 | UT | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 942854058001 | Medicaid | UT |
Other providers in Farr West, UT
- Isabel Kirkham
- Knight Family Dentistry LLC
- Samuel Don Knight
- Spencer Knight
- Taylor Knighton
- Gracey Larue
- Lotus Aesthetics and Wellness
- Chelnecha Hardy Lowry
- Kapuaonalani S Makuakane
- Nathan Harrison Mangum
All providers in Farr West, UT · Family Medicine Physician in Utah
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 14, 2019. 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.