Active NPI
John A. Larsen, MD
- Anesthesiology Physician
- Lakewood, WA
National Provider Identifier
1932128576
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- MD00043782
- Practice address
- 11315 Bridgeport Way SW
Lakewood, WA 98499-3004 - Phone
- (253) 985-6403
- Fax
- (253) 985-2948
- NPI assigned
- Jul 18, 2006
- 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 |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | MD00043782 | WA | Primary |
Addresses
Primary practice location
11315 Bridgeport Way SW
Lakewood, WA 98499-3004
Mailing address
11315 Bridgeport Way SW
Lakewood, WA 98499-3004
Phone (253) 985-6403
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1120435 | Medicaid | WA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | jlarsen199155@fhsce.catholichealth.net |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00043782 | WA | MD | Anesthesiology Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oregon Anesthesiology Group PC | Anesthesiology | Current | Accepting new patients |
Locations
707 SW Washington St
Ste 700
Portland, OR 97205
2211 NE 139th St
Vancouver, WA 98686
Phone (360) 397-1985
Interoperability endpoints
- jlarsen199155@fhsce.catholichealth.net
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": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1597968000000",
"number": "1932128576",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11315 BRIDGEPORT WAY SW",
"city": "LAKEWOOD",
"state": "WA",
"postal_code": "984993004",
"telephone_number": "253-985-6403",
"fax_number": "253-985-2948"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11315 BRIDGEPORT WAY SW",
"city": "LAKEWOOD",
"state": "WA",
"postal_code": "984993004",
"telephone_number": "253-985-6403",
"fax_number": "253-985-2948"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSEN",
"first_name": "JOHN",
"middle_name": "A.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-18",
"last_updated": "2020-08-21",
"certification_date": "2020-08-21",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "WA",
"license": "MD00043782",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1120435",
"state": "WA"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "jlarsen199155@fhsce.catholichealth.net",
"affiliation": "N",
"address_1": "11315 Bridgeport Way SW",
"city": "Lakewood",
"state": "WA",
"country_code": "US",
"postal_code": "984993004",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Lakewood, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2020; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.