Matthew Wayne Larsen, RDN, CDE

Primary specialty

Registered DietitianTaxonomy code 133V00000X

License

59321 Issued in MT

Practice address

210 Sunnyview LN Ste 103
Kalispell, MT 59901

Phone

(406) 257-3872

Fax

(406) 758-7077

NPI assigned

Dec 10, 2009

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MT

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: krmcmedicalrecords@krhdirect.org

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.

• Kalispell Regional Medical Center Inc

  • General Acute Care Hospital
  • Kalispell, MT
  • NPI 1417945627
  Medicare reassignment NPD
• Kalispell Regional Medical Center Inc

  • Surgical Oncology Physician
  • Kalispell, MT
  • NPI 1053790063
  NPD
• Kalispell Regional Medical Center Inc

  • Clinic/Center
  • Kalispell, MT
  • NPI 1235333139
  NPD
• Kalispell Regional Medical Center, Inc

  • Surgery Physician
  • Kalispell, MT
  • NPI 1215527403
  NPD (past)

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

{
    "created_epoch": "1260403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710806400000",
    "number": "1184953739",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 SUNNYVIEW LN STE 103",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "599013128",
            "telephone_number": "406-257-3872",
            "fax_number": "406-758-7077"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 SUNNYVIEW LN STE 103",
            "city": "KALISPELL",
            "state": "MT",
            "postal_code": "59901",
            "telephone_number": "406-257-3872",
            "fax_number": "406-758-7077"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1287 Burns Way",
            "address_purpose": "LOCATION",
            "city": "Kalispell",
            "state": "MT",
            "postal_code": "599013109",
            "country_code": "US",
            "telephone_number": "406-752-8120",
            "fax_number": "406-752-8134",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "MATTHEW",
        "middle_name": "WAYNE",
        "name_prefix": "Mr.",
        "credential": "RDN, CDE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-12-10",
        "last_updated": "2024-03-19",
        "certification_date": "2024-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "133V00000X",
            "taxonomy_group": "",
            "desc": "Dietitian, Registered",
            "state": "MT",
            "license": "59321",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "krmcmedicalrecords@krhdirect.org",
            "affiliation": "Y",
            "affiliationName": "Kalispell Regional Medical Center Inc",
            "address_1": "210 Sunnyview Ln",
            "address_2": "Suite 103",
            "city": "Kalispell",
            "state": "MT",
            "country_code": "US",
            "postal_code": "599013135",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Sierra Langstaff, PHARMD
• Robert Preston Langston, FOSTER CARE PROVIDER
• Libbie Sue Lapp, PAC
• William Keith Lara, MD
• Connie Jo Lard, FNP-C
• Camalla Larson
• Keyawna Janice Larson, SWLC, ACLC
• Sarah E Latcham, NP
• Shanell Kehaulani Latta, M.S.
• Stephen Edwin Latter, DPM

• Registered Dietitian in Kalispell, MT
• Providers in Kalispell, MT by specialty
• Registered Dietitian in Montana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.