Jacob Daniel Larson, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

58776 Issued in CA

Practice address

18655 W Bernardo Dr
San Diego, CA 92127-3099

Phone

(858) 939-9914

NPI assigned

Mar 30, 2019

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Robert Marriott Medical CorpGroup PAC ID 2567531494, 63 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Robert Marriott Medical Corp

  • Surgery Physician
  • El Segundo, CA
  • NPI 1083883938
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1553904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1746489600000",
    "number": "1174084149",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "222 N PACIFIC COAST HWY STE 1420",
            "city": "EL SEGUNDO",
            "state": "CA",
            "postal_code": "902455648",
            "telephone_number": "877-878-3289"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18655 W BERNARDO DR",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921273099",
            "telephone_number": "858-939-9914"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7450 Olivetas Ave",
            "address_purpose": "LOCATION",
            "city": "LA Jolla",
            "state": "CA",
            "postal_code": "920374900",
            "country_code": "US",
            "telephone_number": "858-454-4201",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LARSON",
        "first_name": "JACOB",
        "middle_name": "DANIEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-03-30",
        "last_updated": "2025-05-06",
        "certification_date": "2025-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "CA",
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "58776",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA58776",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Courtney Jeanne Larson
• Craig R Larson
• Derek Thomas Larson, D.O.
• Garth Larson
• Greg R. Larson, D.C.
• James M. Larson, M.D.
• Janna Alfery Larson, M.D.
• Jennifer Leevonne Larson
• Jill Marie Larson, MA
• Julia Larson, MD

• Physician Assistant in San Diego, CA
• Providers in San Diego, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.