NPIMap

Individual provider Active NPI

Kelli Anne Larson, D.O.

  • Family Medicine Physician
  • Polson, MT
National Provider Identifier
1629336953
Registry record updated Oct 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
41446 Issued in MT
Practice address
107 Ridgewater Dr
Polson, MT 59860-8977
Phone
(406) 883-3737
Fax
(406) 883-2669
NPI assigned
Apr 24, 2012
Last updated
Oct 14, 2016By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 14, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 41446 MT Primary

Addresses

Primary practice location

107 Ridgewater Dr
Polson, MT 59860-8977

Mailing address

107 6TH Ave SW
Ronan, MT 59864-2634
Phone (406) 676-4441

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MT
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20150916001809 MT Practitioner - Family Practice 2466685359 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
St Lukes Community HospitalGroup PAC ID 5496659567, shared by 8 NPIs, 59 clinicians

Practice addresses (Care Compare)

104 Rufus LN
Polson, MT 59860-8903
Phone (406) 883-2555

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

State licenses

LicenseStateTypeSpecialty
41446MTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
St. Lukes Community Hospital Family Medicine Current Accepting new patients
St Lukes Community Hospital CurrentSince Jan 6, 2026 Accepting new patients
St Lukes Community Hospital CurrentSince Sep 1, 2015 Accepting new patients
St Lukes Community Hospital CurrentSince Sep 1, 2015 Accepting new patients
St. Lukes Community Hospital Past Accepting new patients

Locations

104 Rufus Ln
Polson, MT 59860
Phone (406) 543-8512

107 6th Ave SW
Ronan, MT 59864
Phone (406) 676-3600

126 6th Ave SW
Ronan, MT 59864
Phone (406) 676-3600

Organizations & group practices 5

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.

Hospital & facility affiliations 10

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

NPI Registry JSON

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

{
    "created_epoch": "1335225600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476403200000",
    "number": "1629336953",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 6TH AVE SW",
            "city": "RONAN",
            "state": "MT",
            "postal_code": "598642634",
            "telephone_number": "406-676-4441",
            "fax_number": "406-676-0835"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 RIDGEWATER DR",
            "city": "POLSON",
            "state": "MT",
            "postal_code": "598608977",
            "telephone_number": "406-883-3737",
            "fax_number": "406-883-2669"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "KELLI",
        "middle_name": "ANNE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-04-24",
        "last_updated": "2016-10-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MT",
            "license": "41446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Polson, MT

Sources for this page

Verify at the official NPI Registry.