Physician Compare National (NPI:1235224932)

HEALTHCARE PROVIDER: RYAN H LARSEN MD

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1235224932
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	3971525064
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20090612000482
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	LARSEN
	Individual professional last name
Provider First Name	RYAN
	Individual professional first name
Provider Middle Name	H
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.
Provider Credential Text	MD
	The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.

Medical School Information
Medical School Name	UNIVERSITY OF UTAH SCHOOL OF MEDICINE
	Individual professional's medical school
Graduation Year	1985
	Individual professional's medical school graduation year
Primary Specialty	UROLOGY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	164 S 5TH ST
	Group Practice or individual's line 1 address
City	MONTPELIER
	Group Practice or individual's city
State	ID
	Group Practice or individual's state
Zip Code	832541557
	Group Practice or individual's zip code (9 digits when available)

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	460017
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	BRIGHAM CITY COMMUNITY HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Hospital Affiliation CCN 2	460054
	Medicare CCN of hospital where individual professional provides service 2
Hospital Affiliation LBN 2	CACHE VALLEY HOSPITAL
	Legal business name of hospital where individual professional provides service 2
Hospital Affiliation CCN 3	460015
	Medicare CCN of hospital where individual professional provides service 3
Hospital Affiliation LBN 3	LOGAN REGIONAL HOSPITAL
	Legal business name of hospital where individual professional provides service 3
Hospital Affiliation CCN 4	131316
	Medicare CCN of hospital where individual professional provides service 4
Hospital Affiliation LBN 4	BEAR LAKE MEMORIAL HOSPITAL
	Legal business name of hospital where individual professional provides service 4
Hospital Affiliation CCN 5	131322
	Medicare CCN of hospital where individual professional provides service 5
Hospital Affiliation LBN 5	FRANKLIN COUNTY MEDICAL CENTER
	Legal business name of hospital where individual professional provides service 5
Professional Accepts Medicare Assignment	Y

Physician Compare National (NPI:1235224932)

HEALTHCARE PROVIDER: RYAN H LARSEN MD

Individual Professional Information

Medical School Information

Practice Information

Hospital(s) Affiliation Information