Individual provider Active NPI

Dane Marc Larsen, M.D.

  • Obstetrics & Gynecology Physician
  • Fishersville, VA
National Provider Identifier
1972569523
Registry record updated Dec 20, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X
License
0101263220 Issued in VA
Practice address
39 Beam LN
Fishersville, VA 22939-2348
Phone
(540) 213-7750
Fax
(540) 213-7750
NPI assigned
Apr 24, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 20, 2023

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Gynecology Physician 207VG0400X 219513 NY
Obstetrics & Gynecology Physician 207V00000X 0101263220 VA Primary

Addresses

Primary practice location

39 Beam LN
Fishersville, VA 22939-2348

Mailing address

PO Box 388
Fishersville, VA 22939-0388
Phone (540) 213-7750

Other identifiers 1

IdentifierTypeStateIssuer
02138829MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dane.larsen.1@14718.direct.athenahealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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
I20171031000575 VA Practitioner - Obstetrics/Gynecology 9133311780 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Obstetrics/Gynecology
Education
Loma Linda University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Select Physical Therapy Holdings IncGroup PAC ID 9537076401, shared by 76 NPIs, 1,992 clinicians
Augusta Medical GroupGroup PAC ID 3678632544, 409 clinicians

Practice addresses (Care Compare)

2303 N Augusta St
Staunton, VA 24401-2597
Phone (540) 886-4510

39 Beam LN
Fishersville, VA 22939-2348
Phone (540) 213-7750

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of the uterus1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
0101263220VAMDObstetrics & Gynecology Physician
219513NYMDGynecology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Augusta Medical Group CurrentSince Dec 1, 2023 Accepting new patients
Augusta Medical Group CurrentSince Dec 1, 2023 Accepting new patients

Locations

540 Radford Ln
Ste 250
Charlottesville, VA 22903
Phone (434) 823-7596

53 S Medical Park Dr
Fishersville, VA 22939
Phone (540) 332-5687

39 Beam Ln
Fishersville, VA 22939
Phone (540) 213-7750

240 Lucy Dr
Harrisonburg, VA 22801
Phone (540) 433-1041

644 University Blvd
Harrisonburg, VA 22801
Phone (540) 564-5100

110 Houston St
Ste C
Lexington, VA 24450
Phone (540) 463-7751

30 Greenhouse Rd
Lexington, VA 24450
Phone (540) 464-3465

Interoperability endpoints

  • Direct secure messaging: dane.larsen.1@14718.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/14718/brand/4/csg/1/fhir/r4

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 and National Provider Directory roles.

Hospital & facility affiliations 1

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": "1145836800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1703030400000",
    "number": "1972569523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 388",
            "city": "FISHERSVILLE",
            "state": "VA",
            "postal_code": "229390388",
            "telephone_number": "540-213-7750",
            "fax_number": "540-213-7755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 BEAM LN",
            "city": "FISHERSVILLE",
            "state": "VA",
            "postal_code": "229392348",
            "telephone_number": "540-213-7750",
            "fax_number": "540-213-7750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "DANE",
        "middle_name": "MARC",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-24",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207VG0400X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology, Gynecology",
            "state": "NY",
            "license": "219513",
            "primary": false
        },
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "VA",
            "license": "0101263220",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "02138829",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dane.larsen.1@14718.direct.athenahealth.com",
            "affiliation": "N",
            "endpointDescription": "Direct Messaging Address",
            "address_1": "39 Beam Ln",
            "city": "Fishersville",
            "state": "VA",
            "country_code": "US",
            "postal_code": "229392348",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Fishersville, VA

Sources for this page

Verify at the official NPI Registry.