Elise Christine Brodin Larson, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

40650 Issued in MN

Practice address

5130 Main St NE
Fridley, MN 55421-1528

Phone

(612) 216-1471

Fax

(833) 972-1587

NPI assigned

Mar 22, 2006

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Elise Christine Brodin Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: elise.larson.1@31026.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Neopath

  • Primary Care Clinic/Center
  • Fridley, MN
  • NPI 1407389364
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1142985600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731024000000",
    "number": "1124087622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "323 WASHINGTON AVE N STE 200",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554012206",
            "telephone_number": "952-698-9860"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5130 MAIN ST NE",
            "city": "FRIDLEY",
            "state": "MN",
            "postal_code": "554211528",
            "telephone_number": "612-216-1471",
            "fax_number": "833-972-1587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "ELISE",
        "middle_name": "CHRISTINE BRODIN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-03-22",
        "last_updated": "2024-11-08",
        "certification_date": "2024-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MN",
            "license": "40650",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ELISE",
            "last_name": "BRODIN",
            "middle_name": "CHRISTINE",
            "prefix": "DR.",
            "credential": "MD",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Mai Mong Lao, LGSW
• Lapinski Family Dentistry PA
• Thomas Jon Lapinski, DDS
• Ellen Renee Larkin, DPT
• Alyssa Ann Larson
• Kelli Suzanne Larson, M.S. CCC-SLP
• Lucie Larson, MD
• Holly Justine Lastine, LCSW, LICSW
• Jennifer Lawrence, LICSW
• Lex Lawson, MD

• Family Medicine Physician in Fridley, MN
• Providers in Fridley, MN by specialty
• Family Medicine Physician in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.