JACK LARSEN
NPI 1972063444
Family Medicine in Johnson City, TN
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 and is a graduate of Other (2019).
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.
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.
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.
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.
JOHNSON CITY, TN 37604
JOHNSON CITY, TN 37604
JOHNSON CITY, TN 37604
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.
What insurance does Jack Larsen accept?
Health plans from Ambetter from Arkansas Health & Wellness, Ambetter from Home State Health, Ambetter from Magnolia Health, Ambetter of Alabama and Ambetter of North Carolina and 3 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.
# Jack Larsen · NPI 1972063444
Family Medicine physician in Johnson City, Tennessee. Individual provider, active in the CMS NPPES registry since March 21, 2019.
## Identity
- **NPI:** 1972063444 (Entity type: Individual)
- **Enumerated:** March 21, 2019
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **State license:** 63135 (Tennessee)
- **Sole proprietor:** No
## Practice location
- **Address:** 917 W WALNUT ST, Johnson City, TN 37604
- **Phone:** (423) 439-6464
## Medicare
- **Medicare:** Enrolled (PECOS); accepts Medicare assignment
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Medical school:** Other, class of 2019
## Record status
- **NPPES last updated:** January 18, 2024
- **Other identifiers:** Medicaid Q050572 (TN)
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Source: [NPI Profile](https://npiprofile.com/npi/1972063444) · Data from the CMS NPPES public registry.