Deactivated NPI 1205928546 Deactivated / Inactive NPI Male Practitioner

Dr. Mitchell Williams Larsen , MD

Orthopaedic Surgery • Provo, UT

⚠️

Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Mitchell Larsen has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date September 28, 2006

NPI Deactivation Date June 26, 2024

Total Practice Duration ~18 Years of Practice (2006 – 2024)

Professional Overview & Biography Verified Profile Summary

Dr. Mitchell Larsen, MD was a registered Orthopaedic Surgery practicing in Provo, UT. Throughout an active medical career spanning 18 years, Dr. Larsen provided care at the practice location at 1055 N 500 W until profile deactivation on 2024-06-26.

Historical Medicare Part B clinical services included injection, triamcinolone acetonide, not otherwise specified, 10 mg, aspiration and/or injection of fluid from large joint, x-ray of shoulder, minimum of 2 views. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

1055 N 500 W
Suite 121

Provo, UT 84064

Telephone 8013737350

Fax 8018125401

Associated Practice Facility / Clinic

🏢 No Roll Up Timpanogos Llc Facility NPI 1831153840

Specialty Benchmarks & Practice Insights

Comparative analytics for Orthopaedic Surgery in Provo, UT

Active Practitioner

Practitioner Clinical Experience

Active

City Avg: 23.0 Yrs

State Avg: 21.4 Yrs

Regional Practice Density

26 Specialists

Practicing in Provo, UT (277 Statewide)

Telehealth Adoption Rate

3.8% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

63.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	225	38	$3.00	$0.92
20610 Aspiration and/or injection of fluid from large joint	58	45	$175.03	$59.81
73030 X-ray of shoulder, minimum of 2 views	56	50	$99.96	$30.92
99213 Established patient office or other outpatient visit, typically 15 minutes	39	36	$152.31	$83.97
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	36	33	$214.89	$120.73
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	28	28	$280.29	$153.18
73564 X-ray of knee, 4 or more views	23	16	$137.74	$43.57
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	21	21	$187.62	$105.25
23472 Prosthetic repair of shoulder joint, total shoulder	21	21	$3112.00	$1358.47
29826 Shaving of part of shoulder bone and repair of ligament using an endoscope	13	13	$1422.00	$160.34

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	549	86	$3.00	$1.07
73030 X-ray of shoulder, minimum of 2 views	191	137	$99.61	$31.63
99213 Established patient office or other outpatient visit, typically 15 minutes	116	99	$149.62	$85.55
20610 Aspiration and/or injection of fluid from large joint	109	90	$186.06	$65.99
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	71	68	$211.62	$121.63
23472 Prosthetic repair of shoulder joint, total shoulder	51	51	$3126.55	$1348.46
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	47	47	$276.94	$156.08
73564 X-ray of knee, 4 or more views	44	35	$135.73	$43.75
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	43	43	$186.14	$106.55
29826 Shaving of part of shoulder bone and repair of ligament using an endoscope	32	31	$1422.00	$164.00
29827 Repair of shoulder rotator cuff using an endoscope	27	25	$2250.19	$1022.09
29828 Release of shoulder biceps tendon using an endoscope	21	20	$1927.05	$511.83
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	18	18	$94.00	$53.48
27447 Replacement of knee joint, both sides of knee	11	11	$3202.00	$1224.67

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	644	97	$3.14	$1.13
99213 Established patient office or other outpatient visit, typically 15 minutes	164	133	$147.92	$86.28
73030 X-ray of shoulder, minimum of 2 views	160	108	$97.54	$31.34
20610 Aspiration and/or injection of fluid from large joint	143	105	$189.57	$66.98
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	95	80	$208.92	$122.75
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	48	48	$186.69	$106.03
73564 X-ray of knee, 4 or more views	47	39	$130.49	$43.24
23472 Prosthetic repair of shoulder joint, total shoulder	40	40	$3219.32	$1351.42
J7323 Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose	38	14	$232.00	$132.54
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	36	36	$286.50	$157.28
29826 Shaving of part of shoulder bone and repair of ligament using an endoscope	28	28	$1415.68	$162.48
29827 Repair of shoulder rotator cuff using an endoscope	25	25	$2363.56	$1006.48
29828 Release of shoulder biceps tendon using an endoscope	15	15	$2028.07	$473.23
73562 X-ray of knee, 3 views	15	13	$110.73	$36.80

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	760	121	$4.81	$1.23
73030 X-ray of shoulder, minimum of 2 views	218	131	$94.40	$30.41
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	159	136	$207.03	$124.01
20610 Aspiration and/or injection of fluid from large joint	149	129	$180.72	$66.03
99213 Established patient office or other outpatient visit, typically 15 minutes	115	101	$145.43	$86.57
73564 X-ray of knee, 4 or more views	49	38	$130.00	$41.52
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	48	48	$283.77	$162.55
23472 Prosthetic repair of shoulder joint, total shoulder	37	35	$3271.00	$1399.41
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	24	24	$184.00	$108.43
29826 Shaving of part of shoulder bone and repair of ligament using an endoscope	21	21	$1374.24	$169.87
73502 X-ray of hip, 2-3 views	17	14	$103.29	$31.71
73562 X-ray of knee, 3 views	17	13	$109.29	$35.23
29824 Partial removal of collar bone at shoulder using an endoscope	15	15	$1480.00	$353.55
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	15	15	$237.00	$131.56
29828 Release of shoulder biceps tendon using an endoscope	13	13	$2029.00	$647.56
27447 Replacement of knee joint, both sides of knee	12	12	$3202.00	$1151.66
20985 Computer-assisted surgery for muscle and bone procedure	12	12	$335.00	$141.66

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	1,202	152	$3.00	$1.45
73030 X-ray of shoulder, minimum of 2 views	356	194	$86.81	$29.02
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	307	223	$195.68	$104.74
20610 Aspiration and/or injection of fluid from large joint	245	152	$183.71	$63.70
99213 Established patient office or other outpatient visit, typically 15 minutes	171	131	$132.26	$72.28
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	87	87	$297.93	$156.59
73564 X-ray of knee, 4 or more views	72	54	$118.58	$39.75
73502 X-ray of hip, 2-3 views	51	29	$104.47	$35.06
23472 Prosthetic repair of shoulder joint, total shoulder	43	43	$3271.00	$1408.19
73562 X-ray of knee, 3 views	38	25	$101.63	$34.07
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	32	31	$372.50	$200.32
73010 X-ray of shoulder blade	31	28	$77.94	$24.83
29826 Shaving of part of shoulder bone and repair of ligament using an endoscope	25	25	$1430.16	$167.10
29827 Repair of shoulder rotator cuff using an endoscope	21	21	$2352.81	$998.11
29824 Partial removal of collar bone at shoulder using an endoscope	18	18	$1479.83	$330.28
27245 Treatment of broken neck of thigh bone with bone implant	17	17	$2825.65	$1232.44
29828 Release of shoulder biceps tendon using an endoscope	17	17	$2029.00	$462.11
36415 Insertion of needle into vein for collection of blood sample	12	11	$10.00	$2.96
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	12	12	$197.00	$105.01
27447 Replacement of knee joint, both sides of knee	11	11	$3210.36	$1362.76

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	1,170	166	$3.00	$1.57
73030 X-ray of shoulder, minimum of 2 views	371	195	$79.60	$26.63
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	300	220	$181.83	$104.88
20610 Aspiration and/or injection of fluid from large joint	251	171	$194.27	$63.99
99213 Established patient office or other outpatient visit, typically 15 minutes	155	122	$122.84	$72.49
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	105	105	$279.70	$160.46
73564 X-ray of knee, 4 or more views	80	63	$112.14	$37.77
73502 X-ray of hip, 2-3 views	43	32	$81.00	$27.46
23472 Prosthetic repair of shoulder joint, total shoulder	43	43	$3277.88	$1456.93
73562 X-ray of knee, 3 views	34	25	$100.74	$33.83
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	33	33	$237.00	$137.33
J7323 Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose	31	11	$376.00	$140.96
73010 X-ray of shoulder blade	30	25	$88.00	$29.12
29826 Shaving of part of shoulder bone and repair of ligament using an endoscope	28	28	$1466.46	$181.86
29827 Repair of shoulder rotator cuff using an endoscope	26	26	$2355.23	$1074.70
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	19	19	$350.00	$202.54
29824 Partial removal of collar bone at shoulder using an endoscope	19	19	$1480.58	$221.76
29828 Release of shoulder biceps tendon using an endoscope	17	17	$2033.24	$502.97
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	15	15	$182.87	$106.62
36415 Insertion of needle into vein for collection of blood sample	14	14	$10.00	$2.94
20985 Computer-assisted surgery for muscle and bone procedure	14	13	$332.86	$152.11
27245 Treatment of broken neck of thigh bone with bone implant	13	13	$2763.00	$1261.76
86140 Measurement C-reactive protein for detection of infection or inflammation	12	12	$11.00	$5.63
27447 Replacement of knee joint, both sides of knee	12	12	$3347.00	$1391.38

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	936	149	$3.00	$1.76
73030 X-ray of shoulder, minimum of 2 views	328	174	$79.68	$26.42
20610 Aspiration and/or injection of fluid from large joint	232	151	$189.23	$61.65
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	225	179	$180.00	$103.33
99213 Established patient office or other outpatient visit, typically 15 minutes	213	162	$122.00	$70.38
73564 X-ray of knee, 4 or more views	83	64	$109.00	$35.47
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	76	76	$276.00	$159.37
J7323 Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose	55	11	$376.00	$143.85
73562 X-ray of knee, 3 views	45	33	$90.11	$29.15
23472 Prosthetic repair of shoulder joint, total shoulder	38	38	$3308.00	$1459.90
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	32	32	$181.00	$105.43
73502 X-ray of hip, 2-3 views	28	17	$104.32	$33.83
29826 Shaving of part of shoulder bone and repair of ligament using an endoscope	25	25	$1412.00	$179.70
27447 Replacement of knee joint, both sides of knee	24	24	$3612.00	$1303.29
20985 Computer-assisted surgery for muscle and bone procedure	23	23	$320.00	$150.57
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	23	23	$237.00	$135.70
29827 Repair of shoulder rotator cuff using an endoscope	21	21	$2380.00	$1058.31
29824 Partial removal of collar bone at shoulder using an endoscope	15	15	$1494.00	$288.21
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	15	15	$72.00	$42.29
27245 Treatment of broken neck of thigh bone with bone implant	13	13	$2834.00	$1243.65
29828 Release of shoulder biceps tendon using an endoscope	11	11	$2053.00	$483.49

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J3301 Injection, triamcinolone acetonide, not otherwise specified, 10 mg	1,038	159	$3.00	$1.77
J7325 Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular injection, 1 mg	640	14	$32.00	$12.55
99213 Established patient office or other outpatient visit, typically 15 minutes	427	272	$116.00	$69.32
73030 X-ray of shoulder, minimum of 2 views	327	182	$77.57	$26.56
20610 Aspiration and/or injection of fluid from large joint	224	144	$161.05	$54.32
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	87	87	$172.00	$99.83
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	69	64	$170.00	$100.54
73564 X-ray of knee, 4 or more views	60	47	$109.00	$36.94
20611 Aspiration and/or injection of fluid large joint using ultrasound guidance	51	30	$184.55	$81.14
23472 Prosthetic repair of shoulder joint, total shoulder	46	45	$3270.00	$1445.30
73562 X-ray of knee, 3 views	28	24	$90.39	$31.12
73502 X-ray of hip, 2-3 views	28	19	$87.64	$30.07
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	27	27	$222.00	$135.15
29826 Shaving of part of shoulder bone and repair of ligament using an endoscope	24	24	$1368.00	$174.64
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	22	22	$262.00	$153.88
73610 X-ray of ankle, minimum of 3 views	19	12	$67.42	$23.07
29827 Repair of shoulder rotator cuff using an endoscope	18	18	$2091.00	$1036.43

Medical Specialties & State Licenses

Orthopaedic Surgery Primary Specialty

NUCC Taxonomy Code: 207X00000X

State License UT 5777288-1205

An orthopaedic surgeon is trained in the preservation, investigation and restoration of the form and function of the extremities, spine and associated structures by medical, surgical and physical means. An orthopaedic surgeon is involved with the care of patients whose musculoskeletal problems include congenital deformities, trauma, infections, tumors, metabolic disturbances of the musculoskeletal system, deformities, injuries and degenerative diseases of the spine, hands, feet, knee, hip, shoulder and elbow in children and adults. An orthopaedic surgeon is also concerned with primary and secondary muscular problems and the effects of central or peripheral nervous system lesions of the musculoskeletal system.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

35 Associated Practitioners

Dr. Scott Evans , MD

Orthopaedic Surgery - Hand Surgery

NPI 1033435045

Doctor of Medicine (M.D.)

Dr. Evan Nielsen , MD

Orthopaedic Surgery

NPI 1043527260

Doctor of Medicine (M.D.)

Zachary Golden , PA

Physician Assistant

NPI 1053856542

Physician Assistant

Dr. Bradford Matthews , MD

Orthopaedic Surgery

NPI 1063523959

Doctor of Medicine (M.D.)

Eric Leach , PA-C

Physician Assistant

NPI 1124068739

Physician Assistant (Certified)

Dr. Jeffrey Wallentine , MD

Orthopaedic Surgery

NPI 1124121934

Doctor of Medicine (M.D.)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

8 Historical Events

⚠️

NPI Profile Deactivated June 26, 2024

Record deactivated on June 26, 2024

📍

Updated Business Mailing Address November 12, 2018

Registered at 1055 N 500 W, ATTN: CREDENTIALING, PROVO, UT 846043305 (Tel: 8013548225)

✅

NPI Profile Active December 09, 2014

NPI status registered as active in NPPES database

📍

Updated Practice Location December 09, 2014

Registered at 1055 N 500 W, SUITE 121, PROVO, UT 84064 (Tel: 8013737350)

📍

Updated Business Mailing Address December 09, 2014

Registered at 1055 N 500 W, PROVO, UT 846043305 (Tel: 8013737350)

👤

Provider Name / Credentials Updated December 09, 2014

Recorded as MITCHELL LARSEN, MD

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) December 09, 2014

Orthopaedic Surgery (License #5777288-1205 in UT)

🟢

Initial NPI Registration & Enumeration September 28, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1205928546

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: September 28, 2006

Last Update: December 09, 2014

Deactivation Date: June 26, 2024

Update or Correct Profile

Mailing Address

1055 N 500 W

Provo, UT 846043305

Phone: 8013737350

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.