DR. SPENCER LARSON (DO) – Family Medicine Physician, NPI 1790300143

DR. SPENCER LARSON (DO) is a healthcare provider. based in Tooele, Utah. specializing in FAMILY PRACTICE. They hold the professional credentials DO. They hold a License No. 13185617-1204 (UT). The NPI Number for DR. SPENCER LARSON (DO) is 1790300143

Main info

Male
6 Years Of Experience
Accepts Medicare Assignment
Name
DR. SPENCER LARSON (DO)
NPI
1790300143
Phone
(435) 843-1225
Address
2376 N 400 E STE 102
Enumeration Date
11 June 2020
Last Update Date
11 March 2026

Doctor Profile

Medical School Name
ARIZONA COLLEGE OF OSTEOPATHIC MEDICINE MID WESTERN UNIVERSITY
Secondary Phone
4358431225
Graduation Year
2020 (6 years ago)
PAC ID
5597139006
Group Practice PAC ID
2062505852
Professional Enrollment ID
I20230324000620
Address ID
UT840743413TO2376XEXXX401
Telehealth
Yes
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience39
Completeness85
Years active:5State licenses:1Digital endpointsOther names

1,136 FAMILY PRACTICE in UT

Provider Addresses for DR. SPENCER LARSON (DO)

  • 2376 N 400 E STE 102

    TOOELE, UT 840743413

    Phone: (435) 843-1225

    Fax: (435) 843-1228

    Type: Mailing

  • 1316 S PROVIDENCE CIR

    MESA, AZ 852093759

    Phone:

    Type: Mailing

  • 1301 S CRISMON RD

    MESA, AZ 852093767

    Phone: (480) 358-6100

    Type: Location

  • 267 E VENTURA BLVD

    STANSBURY PARK, UT 840749327

    Phone: (801) 854-8629

    Type: Mailing

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

CMS reports 44 Open Payments records for all available years, with a total value of $874.

Total Amount is formed as General ($874) + Research ($0) + Ownership ($0) = $874.

Last reported payment date: 2024-12-12 • Largest payer in this snapshot: Mylan Specialty L.P. ($228).

Total Amount

$874

General + Research + Ownership

Payments

44

Total payment records

General Amount

$874

General payments

Research Amount

$0

Research funding

Ownership Amount

$0

Ownership interests

Ownership Count

0

Ownership records

Last Payment Date

2024-12-12

Latest reported date

Top Companies

Largest payers in this snapshot

View all Open Payments →|Open Payments Risk Radar →

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: 2023-03-24

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20230324000620IFamily PracticeUTTBD

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.

Verify on CMS Revalidation Lookup Tool

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

HCPCSDescriptionServicesBeneficiariesMedicare allowed
99215Established patient office or other outpatient visit, 40-54 minutes15380$0
G2212Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or7752$0
99214Established patient office or other outpatient visit, 30-39 minutes7454$0
99212Established patient office or other outpatient visit, 10-19 minutes2419$0
90686Influenza vaccine, quadrivalent, preservative free, 0.5 ml dosage2323$0
View full utilization report →

Insurance plans in this area (ZIP 84074)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 2062505852View full group profile
NameSpecialtyState
Family PracticeUT

Reviews

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Frequently asked questions

Can I verify DR. SPENCER LARSON (DO) with an NPI only?
You can start verification with NPI 1790300143 for DR. SPENCER LARSON (DO), then check state licensing separately.
Is DR. SPENCER LARSON (DO) listed as active for patients and plans?
The listing shows DR. SPENCER LARSON (DO) as active in the NPI system.
What healthcare role does DR. SPENCER LARSON (DO) hold?
Scheduling teams often label DR. SPENCER LARSON (DO) under Family Medicine Physician. Clinical services aligned with this taxonomy classification.
Where is DR. SPENCER LARSON (DO) based?
DR. SPENCER LARSON (DO) is tied to Tooele, Utah in the data we show; additional addresses may exist on the full record.
How many locations tie to this NPI?
5 practice locations appear in the available data.

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