JEANNIE THERESE LARSON (MD) – MOHS-Micrographic Surgery Physician, NPI 1164406369
MOHS-Micrographic Surgery Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
419 DERMATOLOGY in MN
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Provider Addresses for JEANNIE THERESE LARSON (MD)
33rd Avenue South, Wenonah, Minneapolis, Hennepin County, Minnesota, 55417, United States
P.O. BOX 1309 MAIL STOP 21110Q
MINNEAPOLIS, MN 554254516
Phone: (952) 993-3260
Type: Mailing
9555, Upland Lane North, Maple Grove, Hennepin County, Minnesota, 55369, United States
MAPLE GROVE, MN 55369
Phone: (952) 993-3260
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
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Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2010-10-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20101013000605 | I | Dermatology | MN | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 17311 | Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks | 117 | 96 | $0 |
| 17312 | Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks | 86 | 58 | $0 |
| 12052 | Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.6-5.0 cm | 37 | 36 | $0 |
| 12032 | Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm | 36 | 33 | $0 |
| 99212 | Established patient office or other outpatient visit, 10-19 minutes | 28 | 20 | $0 |
Insurance plans in this area (ZIP 55425)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| DERMATOLOGY | MN | 11101 | Biopsy of each additional growth of skin and/or tissue | 39 | 21 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| O B S T E T R I C S/ G Y N E C O L O G Y | MN | |
| Family Practice | MN | |
| - | MN | |
| Pulmonary Disease, Critical Care (Intensivists), Internal Medicine | MN | |
| Cardiac Electrophysiology | MN | |
| Family Practice | MN | |
| Physician Assistant | MN | |
| Physical Therapist In Private Practice | MN | |
| Physician Assistant | MN | |
| D E R M A T O L O G Y | MN |
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