Kyle Anthony Larson, DPT

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

14996-24 Issued in WI

Practice address

417 3Rd Avenue
Clear Lake, WI 54005-8905

Phone

(715) 263-4103

Fax

(715) 263-4110

NPI assigned

May 27, 2020

Last updated

May 27, 2020By the provider in NPPES

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 WI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Clear Lake Physical Therapy and Rehab Specialists LLCGroup PAC ID 0749327526, 4 clinicians

Practice addresses (Care Compare)

Merit-based Incentive Payment System (MIPS)

Final score

83.07 of 100Reported as group

Quality

99.91

Improvement activities

40

Cost

43.69

Medicare enrollment (NPD)

Enrolled

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Clear Lake Physical Therapy and Rehab Specialists LLC

  • Physical Therapist
  • Clear Lake, WI
  • NPI 1083845754
  Medicare reassignment Care Compare group NPD
• Clear Lake Physical Therapy and Rehab Specialists LLC

  • Physical Therapy Clinic/Center
  • Prairie Farm, WI
  • NPI 1083328785
  NPD

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

{
    "created_epoch": "1590537600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590537600000",
    "number": "1245853175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 147",
            "city": "CLEAR LAKE",
            "state": "WI",
            "postal_code": "540050147",
            "telephone_number": "715-263-4103",
            "fax_number": "715-263-4110"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 3RD AVENUE",
            "city": "CLEAR LAKE",
            "state": "WI",
            "postal_code": "540058905",
            "telephone_number": "715-263-4103",
            "fax_number": "715-263-4110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "KYLE",
        "middle_name": "ANTHONY",
        "credential": "DPT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-05-27",
        "last_updated": "2020-05-27",
        "certification_date": "2020-05-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "WI",
            "license": "14996-24",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Physical Therapist in Clear Lake, WI
• Providers in Clear Lake, WI by specialty
• Physical Therapist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 27, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.