REBECCA J LARSON (NPI# 1063674588) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063674588 |
| Entity Type | Individual |
| Full Name | REBECCA J LARSON |
| Credential | MD |
| Practice Address |
751 N Rutledge St Suite 2300 Springfield IL 62702-4968 |
| Mailing Address |
Po Box 19644 Springfield IL 62794-9644 |
| Practice Telephone | 2175458000 |
| Practice Fax Number | 2175454485 |
| Mailing Telephone | 2175458000 |
| Mailing Fax Number | 2175454485 |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2020-10-22 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207N00000X | Dermatology | 036-132957 | IL | Allopathic & Osteopathic Physicians |
| Y | 207ND0101X |
Dermatology Specialization: MOHS-Micrographic Surgery |
036-132957 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036132957 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083164578 | Rebecca Marie Larson | Behavioral Analyst | 7705 Barnside Ct, Severn, MD 21144-1325 | 2016-10-07 |
| 1215302716 | Rebecca Sutton Larson | Social Worker | 111 W High St Ste 204, Elkton, MD 21921-8611 | 2015-12-09 |
| 1700499043 | Rebecca Elizabeth Larson | Pharmacist | 455 Highway 61 N, Hannibal, MO 63401-2885 | 2020-08-26 |
| 1417371469 | Rebecca Larson | Radiologic Technologist | 6709 S Minnesota Ave Ste 203, Sioux Falls, SD 57108-2593 | 2014-02-11 |
| 1093043630 | Rebecca Larson | Radiologic Technologist | 1101 E Elizabeth St, Fort Collins, CO 80524-4022 | 2009-11-19 |
| 1679711063 | Rebecca Larson | Counselor | 2111 Exchange St, Astoria, OR 97103-3329 | 2009-01-23 |
| 1720195167 | Rebecca Ann Larson | Nurse Practitioner | 440 Woodward Ave, Iron Mountain, MI 49801-4631 | 2006-08-23 |
| 1841239910 | Rebecca L Larson | Optometrist | 5129 S Western Ave, Sioux Falls, SD 57108-2670 | 2006-06-05 |
| Street Address |
751 N RUTLEDGE ST SUITE 2300 |
| City | SPRINGFIELD |
| State | IL |
| Zip Code | 62702-4968 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023011863 | Lucinda S Buescher | Dermatology | 751 N Rutledge St, Springfield, IL 62702-4909 | 2005-05-24 |
| 1831798933 | Robin E Simon | Nurse Practitioner | 751 N Rutledge St, Springfield, IL 62702-4968 | 2020-10-20 |
| 1891308185 | Whitney Ringer | Nurse Practitioner | 751 N Rutledge St, Springfield, IL 62702-4968 | 2020-08-26 |
| 1518581149 | Aliza Hasan | Dermatology | 751 N Rutledge St, Springfield, IL 62702-4968 | 2020-05-29 |
| 1215559943 | Sindhu Reddy Pisati | Psychiatry & Neurology | 751 N Rutledge St, Springfield, IL 62702-4968 | 2020-05-15 |
| 1205458270 | Paul Hyatt Guerin | Psychiatry & Neurology | 751 N Rutledge St, Springfield, IL 62702-4968 | 2020-05-13 |
| 1215597398 | Alireza Showraki | Internal Medicine | 751 N Rutledge St, Springfield, IL 62702-4968 | 2019-06-19 |
| 1881252013 | Andrew Paul Thaliath | Internal Medicine | 751 N Rutledge St, Springfield, IL 62702-4968 | 2019-06-03 |
| 1891352126 | Emily M Ackerman | Nurse Practitioner | 751 N Rutledge St, Springfield, IL 62702-4968 | 2019-05-22 |
| 1245725308 | Cory Edward Sykora | Psychiatry & Neurology | 751 N Rutledge St, Springfield, IL 62702-4968 | 2018-06-29 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1457866519 | Mohammad Jamal Uddin Ansari | Internal Medicine | 751 N Rutledge St Ste 400, Springfield, IL 62702 | 2017-12-11 |
| 1588105811 | Mickey Graphia | Surgery | 701 N 1st St # D346, Springfield, IL 62702 | 2017-03-20 |
| 1376908913 | Abdul Hannan | Internal Medicine | 315 W Carpenter St # B, Springfield, IL 62702 | 2015-12-28 |
| 1871986414 | Rachel Hoselton | Nurse Practitioner | 400 N 9th St Fl 4, Springfield, IL 62702 | 2015-03-06 |
| 1548697774 | Alyssa Wilson | Behavioral Analyst | 232 Bruns Lane, One Sparcenter Plaza, Springfield, IL 62702 | 2013-10-02 |
| 1174965446 | Amy Wilson | Speech-Language Pathologist | 2120 West Washington Street, Springfield, IL 62702 | 2013-07-26 |
| 1275898116 | Pele Boutrous Dina | Pediatrics | 415 N 9th St # 4w16, Springfield, IL 62702 | 2012-07-06 |
| 1427327733 | Brook D Croke | Genetic Counselor, MS | 400 N. 9th Street, 3rd Floor Clinic B, Springfield, IL 62702 | 2011-12-16 |
| 1629352604 | Renae M Sanchez | Pharmacist | 3216 East Clearlake Ave, Springfield, IL 62702 | 2011-10-07 |
| 1982915302 | William Leland Zelkovich | Radiology | 701 N 1st, Springfield, IL 62702 | 2010-06-30 |
| Find all providers in zip 62702 | ||||
| Taxonomy Code | 207ND0101X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Dermatology |
| Specialization | MOHS-Micrographic Surgery |
| The highly-trained surgeons that perform Mohs Micrographic Surgery are specialists both in dermatology and pathology. With their extensive knowledge of the skin and unique pathological skills, they are able to remove only diseased tissue, preserving healthy tissue and minimizing the cosmetic impact of the surgery. Mohs surgeons who belong to the American College of Mohs Surgery (ACMS) have completed a minimum of one year of fellowship training at one of the ACMS-approved training centers in the U.S. |
| Notes: Source: American College of Mohs Surgery, 2007 [1/1/2008: added definition, added source] Additional Resources: Additional Resources: http://www.mohscollege.org/; American Board of Dermatology, 2007. http://www.abderm.org/ |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578129599 | Metro Mohs Surgery Center, LLC | Dermatology | 5501 Backlick Rd Ste 120, Springfield, VA 22151-3940 | 2019-05-15 |
| 1972913259 | Lindsey Fix | Dermatology | 1605 G St, Springfield, OR 97477 | 2014-05-07 |
| 1982040069 | Bridget E Mcilwee | Dermatology | 1025 S 6th St, Springfield, IL 62703-2403 | 2013-05-16 |
| 1861495699 | Robert A Buzzell | Dermatology | 751 N Rutledge St, Springfield, IL 62702-4909 | 2005-05-24 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1295374270 | Lilly Aesthetics Sc | Dermatology | 2500 S Highland Ave Ste 220, Lombard, IL 60148-7103 | 2019-12-23 |
| 1194270637 | University Dermatology and Vein Clinic LLC | Dermatology | 8110 Cass Ave, Darien, IL 60561-5013 | 2016-08-24 |
| 1174984959 | Advanced Skin and Mohs Surgery Center S.c. | Dermatology | 2845 N. Sheridan Road, Ste 912, Chicago, IL 60657 | 2016-03-08 |
| 1376915629 | Forefront Dermatology, S.c. | Dermatology | 1520 Bond St, Naperville, IL 60563 | 2015-10-27 |
| 1710294756 | Tracy Campbell Md LLC | Dermatology | 675 W North Ave Ste 506, Melrose Park, IL 60160-1626 | 2010-09-13 |
| 1932388865 | Marsh Dermatology, Sc | Dermatology | 1252 American Way, Libertyville, IL 60048-3936 | 2007-10-27 |
| 1538200308 | Omeed Memar | Dermatology | 50 E Washington St Ste 200, Chicago, IL 60602-2154 | 2007-02-12 |
| 1891721965 | Aleksandar L Krunic | Dermatology | 5140 N California Ave Ste 660, Chicago, IL 60625-3664 | 2006-06-23 |
| 1073595690 | Ashish C Bhatia | Dermatology | 550 E Devon Ave Ste 200, Itasca, IL 60143-2639 | 2005-11-18 |
| 1538153960 | Sharon Louise Horton | Dermatology | 1049 E Wilson St, Suite 190, Batavia, IL 60510-2474 | 2005-08-31 |
| Find all providers with the same taxonomy | ||||
| City | SPRINGFIELD |
| Zip Code | 62702 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.