Individual provider Active NPI

Madeline Jo Larson, PA-C

  • Physician Assistant
  • Lafayette, CO
National Provider Identifier
1366247173
Registry record updated Aug 19, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.0009316 Issued in CO
Practice address
1140 W South Boulder Rd Ste 202
Lafayette, CO 80026-8910
Phone
(303) 604-1444
NPI assigned
Feb 17, 2025
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 19, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X PA.0009316 CO
Physician Assistant 363A00000X PA.0009316 CO Primary

Addresses

Primary practice location

1140 W South Boulder Rd Ste 202
Lafayette, CO 80026-8910

Mailing address

1140 W South Boulder Rd Ste 202
Lafayette, CO 80026-8910
Phone (303) 604-1444

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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

Enrollment IDStateProvider typePAC IDDetails
I20250903002102 CO Practitioner - Physician Assistant 2466954151 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2025
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Boulder Valley Center for Dermatology LLCGroup PAC ID 9335037159, 8 clinicians

Practice addresses (Care Compare)

1140 W S Boulder Rd
Suite 202
Lafayette, CO 80026-8910
Phone (303) 604-1444

1610 Prairie Ctr Pkwy
Suite 2230
Brighton, CO 80601-4008
Phone (303) 604-1444

3000 Ctr Green Dr
Suite 260
Boulder, CO 80301-2319
Phone (303) 604-1444

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA.0009316COMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Boulder Valley Center for Dermatology LLC Dermatology PastSince Aug 25, 2025 Accepting new patients

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/2831/brand/1/csg/1/fhir/r4

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1739750400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1755561600000",
    "number": "1366247173",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1140 W SOUTH BOULDER RD STE 202",
            "city": "LAFAYETTE",
            "state": "CO",
            "postal_code": "800268910",
            "telephone_number": "303-604-1444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1140 W SOUTH BOULDER RD STE 202",
            "city": "LAFAYETTE",
            "state": "CO",
            "postal_code": "800268910",
            "telephone_number": "303-604-1444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "MADELINE",
        "middle_name": "JO",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-02-17",
        "last_updated": "2025-08-19",
        "certification_date": "2025-08-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CO",
            "license": "PA.0009316",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CO",
            "license": "PA.0009316",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lafayette, CO

Sources for this page

Verify at the official NPI Registry.