Individual provider Active NPI

Amanda Ann Larsen, MD

  • Neurology Physician
  • Murray, UT
National Provider Identifier
1992333868
Registry record updated Nov 26, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neurology PhysicianTaxonomy code 2084N0400X
License
12401792-1205 Issued in UT
Practice address
5171 S Cottonwood St Ste 810
Murray, UT 84107-5705
Phone
(801) 507-9800
NPI assigned
Mar 27, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 26, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neurology Physician 2084N0400X 12401792-1205 UT Primary

Addresses

Primary practice location

5171 S Cottonwood St Ste 810
Murray, UT 84107-5705

Mailing address

PO Box 27128
Salt Lake City, UT 84132-0001

Other practice location 1

175 N Medical Drive East
Salt Lake City, UT 84132-0001
Phone (801) 585-5405

Other names 1

  • Amanda Ellgen Former name

Electronic endpoints 2

TypeEndpointUseAffiliation
CONNECT URL https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service Other Bluemark LLC/ Office Ally
Direct Messaging Address aellgen439925@direct.med.utah.edu Direct University of Utah

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in UT, CO2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20240610002832 UT Practitioner - Neurology 0042615106 Reassigns benefits to 2 organizations
I20241015001762 CO Practitioner - Neurology 0042615106 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Neurology
Education
University of Colorado School of Medicine, Aurora, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Ihc Health Services IncGroup PAC ID 1850209420, 3,948 clinicians

Practice addresses (Care Compare)

5171 S Cottonwood St
Suite 810
Murray, UT 84107-5705
Phone (801) 507-9800

Hospital & facility affiliations

  • LDS Hospital Hospital, Salt Lake City, UT, CCN 460006
  • Intermountain Health Logan Regional Hospital Hospital, Logan, UT, CCN 460015

Merit-based Incentive Payment System (MIPS)

Final score
89.77 of 100Reported as group
Quality
91.47
Promoting interoperability
100
Improvement activities
40
Cost
74.42

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
12401792-1205UTMDNeurology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University of Utah Adult Services Current Accepting new patients
Ihc Health Services Inc CurrentSince Aug 10, 2025 Accepting new patients
Ihc Health Services, Inc. CurrentSince Aug 10, 2025 Accepting new patients
Ihc Health Services Inc Current Accepting new patients
Colorado West Healthcare System CurrentSince Sep 1, 2024 Accepting new patients
University of Utah Adult Services CurrentSince May 1, 2024 Accepting new patients
University of Utah Adult Services CurrentSince May 1, 2024 Accepting new patients
Colorado West Healthcare System CurrentSince Sep 1, 2024 Accepting new patients

Locations

2351 G Rd
Grand Junction, CO 81505
Phone (970) 242-0920

700 S Highway 99
Ste 3
Fillmore, UT 84631
Phone (435) 743-5555

5171 S Cottonwood St
Ste 810
Salt Lake City, UT 84107
Phone (801) 507-9800

50 N Medical Dr
Slc, UT 84132
Phone (801) 581-2292

175 N Medical Dr
Slc, UT 84112
Phone (801) 581-6908

1300 SE Cardinal Ct
Ste 190
Vancouver, WA 98683
Phone (360) 448-4479

Interoperability endpoints

  • Direct secure messaging: aellgen439925@direct.med.utah.edu

Organizations & group practices 8

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 2

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": "1585267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1764115200000",
    "number": "1992333868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 27128",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841320001"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5171 S COTTONWOOD ST STE 810",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841075705",
            "telephone_number": "801-507-9800"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "175 N Medical Drive East",
            "address_purpose": "LOCATION",
            "city": "Salt Lake City",
            "state": "UT",
            "postal_code": "841320001",
            "country_code": "US",
            "telephone_number": "801-585-5405",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "AMANDA",
        "middle_name": "ANN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-03-27",
        "last_updated": "2025-11-26",
        "certification_date": "2025-11-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084N0400X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Neurology",
            "state": "UT",
            "license": "12401792-1205",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.officeally.io:8291/Gateway/DocumentSubmission/2_0/NhinService/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.2019.3",
            "affiliationName": "Bluemark LLC/ Office Ally",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "address_1": "1300 SE Cardinal Ct Ste 190",
            "city": "Vancouver",
            "state": "WA",
            "country_code": "US",
            "postal_code": "986839683",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "aellgen439925@direct.med.utah.edu",
            "affiliation": "Y",
            "affiliationName": "University of Utah",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CDA/CCD/TXT",
            "address_1": "50 N Medical Dr",
            "city": "Salt Lake City",
            "state": "UT",
            "country_code": "US",
            "postal_code": "841320001",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "AMANDA",
            "last_name": "ELLGEN",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Murray, UT

Sources for this page

Verify at the official NPI Registry.