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JACK LARSEN
NPI 1972063444
Family Medicine in Johnson City, TN

Active since March 21, 2019PECOS EnrolledAccepts Medicare Assignment
917 W WALNUT ST, JOHNSON CITY, TN 37604(423) 439-6464 Get Directions Write a Review

NPPES record last updated: January 18, 2024. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Aug 29, 2023, Jun 6, 2022, Sep 13, 2019 and 1 more (4 updates tracked since 2019).

About Jack Larsen NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JACK LARSEN (NPI 1972063444) is an individual family medicine provider in Johnson City, Tennessee, licensed in Tennessee (63135) and active in the NPI registry since March 2019. He is enrolled in Medicare PECOS, maintains 3 additional practice locations, and is a graduate of Other (2019).

NPPES Registry Identity

NPI1972063444
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameJACK LARSEN
Location Address917 W WALNUT STJohnson City, TN 37604
Mailing AddressPo Box 699Mountain Home, TN 37684-0699 · (423) 433-6050
Phone(423) 439-6464
Sole ProprietorNo
Medical School CMSOtherGraduated 2019
Enumeration DateMarch 21, 2019
Last NPPES UpdateJanuary 18, 20244 updates tracked since enumeration
NPPES CertifiedJanuary 18, 2024
✔ NPI 1972063444 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in TN · 63135
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
917 W WALNUT ST, Johnson City, TN 37604
Open in Google Maps ↗

Secondary Practice Locations 3

Location 1208 Medical Park BlvdBristol, TN 37620 · Phone (423) 989-4050
Location 2102 E Ravine RdKingsport, TN 37660-3814 · Phone (423) 245-9600
Location 3100 Newell DriveGainesville, FL 32610-3814 · Phone (352) 265-4357

Other Identifiers 1

MedicaidQ050572TN

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Ambetter from Arkansas Health & Wellness, Ambetter Health, Ambetter of Alabama and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Jack Larsen is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID3375878929
PECOS Enrollment IDI20230802003172
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Jack Larsen reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Medical Education Assistance Corporation
3.2 mi
Internal Medicine
101 MED TECH PKWY STE 306
Johnson City, TN 37604
  • Reassigned Medicare billing, Tennessee enrollment
  • 341 clinicians in this Medicare group
NPI 1235180480 (423) 433-6039

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 37604 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$81.53 typical visit price
range $52.64 – $160.89
Typical copayment $20.38 (range $13.16 – $40.22)
Most-billed visit code 99203
Established Patient
$93.60 typical visit price
range $16.72 – $131.41
Typical copayment $23.40 (range $4.18 – $32.85)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NIKITA MARIE THOMPSON
Social Worker (Clinical)
917 W WALNUT ST
JOHNSON CITY, TN 37604
Washington County (423) 439-6464
SALLY ELIZABETH CHIKOMB
Student in an Organized Health Care Education/Training Program
917 W WALNUT ST
JOHNSON CITY, TN 37604
Washington County (423) 439-6464
MEDICAL EDUCATION ASSISTANCE CORPORATION
Family Medicine
917 W WALNUT ST
JOHNSON CITY, TN 37604
Washington County (423) 439-6464
AUSTIN B HASH DO
Student in an Organized Health Care Education/Training Program
917 W WALNUT ST
JOHNSON CITY, TN 37604
Washington County (423) 439-6464
LUKE STANLEY
Student in an Organized Health Care Education/Training Program
917 W WALNUT ST
JOHNSON CITY, TN 37604
Washington County (423) 439-7118
DR. PAIGE MCCLEAR DO
Family Medicine
917 W WALNUT ST
JOHNSON CITY, TN 37604
Washington County (423) 439-6464
JIM L WILSON M.D.
Family Medicine
917 W WALNUT ST
JOHNSON CITY, TN 37604
Washington County (423) 439-6464
JOYCE ANNE TROXLER MD
Family Medicine
917 W WALNUT ST
JOHNSON CITY, TN 37604
Washington County (423) 439-6464

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jack Larsen's NPI number?

The NPI number for Jack Larsen is 1972063444. It was assigned to this individual provider in the NPPES registry on March 21, 2019.

Where is Jack Larsen located?

Jack Larsen practices at 917 W Walnut St, Johnson City, TN 37604. The listed phone number is (423) 439-6464.

What is Jack Larsen's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Jack Larsen enrolled in Medicare?

Yes. Jack Larsen is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Jack Larsen's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Jack Larsen reassigns Medicare benefits to Medical Education Assistance Corporation (Johnson City, TN). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Jack Larsen's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Jack Larsen accept?

Health plans from Ambetter Health, Ambetter from Arkansas Health & Wellness, Ambetter of Alabama, Ambetter of North Carolina and Ambetter of Tennessee and 2 other insurers list Jack Larsen as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Jack Larsen was last updated on January 18, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.