Brandon Leon Larsen, PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA-1985 Issued in ID

Practice address

1301 E 17TH St
Idaho Falls, ID 83404-6273

Phone

(208) 991-4296

Fax

(208) 656-2846

NPI assigned

Dec 13, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in ID

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

May accept Medicare assignment

Group practices

Adolpho Enterprise LLC. 6 clinicians

Falls Medical Aesthetics PLLC 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Mountain View Hospital Hospital, Idaho Falls, ID, CCN 130065

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/IIGACD/Endpoint/IIGACD
• FHIR API: https://fhir4.healow.com/fhir/r4/IIGACD

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.

• Falls Medical Aesthetics, PLLC

  • Clinic/Center
  • Idaho Falls, ID
  • NPI 1831730118

  ID

  Medicare reassignment Care Compare group NPD (past)
• Adolpho Enterprise LLC.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Boise, ID
  • NPI 1932454642

  ID

  Medicare reassignment Care Compare group
• Adolpho Enterprise LLC.

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Boise, ID
  • NPI 1063340586
  NPD (past)

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Mountain View Hospital LLC

  • General Acute Care Hospital
  • Idaho Falls, ID
  • NPI 1669462362

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1607817600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1731974400000",
    "number": "1215523337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "891 TIE BREAKER DR",
            "city": "AMMON",
            "state": "ID",
            "postal_code": "834064554",
            "telephone_number": "208-569-8676"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1301 E 17TH ST",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834046273",
            "telephone_number": "208-991-4296",
            "fax_number": "208-656-2846"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3760 Washington Pkwy",
            "address_purpose": "LOCATION",
            "city": "Idaho Falls",
            "state": "ID",
            "postal_code": "834047593",
            "country_code": "US",
            "telephone_number": "208-881-5779",
            "fax_number": "888-326-6076",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "BRANDON",
        "middle_name": "LEON",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-12-13",
        "last_updated": "2024-11-19",
        "certification_date": "2024-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "ID",
            "license": "PA-1985",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sari Jane Landers, RDN, LDN
• Jaxson Landon, DC
• Kira C Lane, LPC3502
• Robert Lang, LCPC
• Linda Lanham
• Matthew F Larsen, DO
• Paul Lorenzo Larsen, PA-C
• Steven J. Larsen, FAGD DDS
• Boyd Eric Larson, PA-C
• Brandy Lee Larson, FNP

• All providers in Idaho Falls, ID
• Medical Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 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; 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.