Brett C Larsen, PA

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

6704805-1206 Issued in UT

Practice address

210 W 300 N
75-3
Roosevelt, UT 84066-2336

Phone

(435) 722-3971

Fax

(435) 722-9291

NPI assigned

Oct 9, 2007

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 UT, MS, WY3 enrollments

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 3

Specialty

Physician Assistant

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Evanston Clinic CorpGroup PAC ID 8325038094, 24 clinicians

Natchez Clinic Company LLCGroup PAC ID 6406178789, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Merit Health Natchez Hospital, Natchez, MS, CCN 250084
• Evanston Regional Hospital Hospital, Evanston, WY, CCN 531319

Merit-based Incentive Payment System (MIPS)

Final score

89.32 of 100Reported as apm

Quality

71.89

Promoting interoperability

100

Improvement activities

40

Merit-based Incentive Payment System (MIPS)

Final score

88.07 of 100Reported as apm

Quality

73.89

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: brett.larsen.1@1583.direct.athenahealth.com

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.

• Evanston Clinic Corp

  • Family Medicine Physician
  • Evanston, WY
  • NPI 1013916519

  Physician Assistant

  Medicare reassignment Care Compare group NPD
• Natchez Clinic Company LLC

  • Internal Medicine Physician
  • Natchez, MS
  • NPI 1881003184
  Medicare reassignment Care Compare group
• Northeastern Utah Medical Group

  • Family Medicine Physician
  • Roosevelt, UT
  • NPI 1982664199
  Medicare reassignment NPD
• Uintah Basin Medical Center

  • General Acute Care Hospital
  • Roosevelt, UT
  • NPI 1871556217
  Medicare reassignment NPD
• Uintah Basin Medical Center

  • Community/Retail Pharmacy
  • Vernal, UT
  • NPI 1285420414
  NPD

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

• Evanston Hospital Corporation

  • General Acute Care Hospital
  • Evanston, WY
  • NPI 1639140015
  Care Compare affiliation
• Natchez Hospital Company LLC

  • General Acute Care Hospital
  • Natchez, MS
  • NPI 1164821559
  Care Compare affiliation

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

{
    "created_epoch": "1191888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1205366400000",
    "number": "1639367337",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 W 300 N",
            "address_2": "75-3",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840662336",
            "telephone_number": "435-722-3971",
            "fax_number": "435-722-9291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 W 300 N",
            "address_2": "75-3",
            "city": "ROOSEVELT",
            "state": "UT",
            "postal_code": "840662336",
            "telephone_number": "435-722-3971",
            "fax_number": "435-722-9291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "BRETT",
        "middle_name": "C",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-10-09",
        "last_updated": "2008-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "6704805-1206",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Steven R Knight, CRNA
• Jason Kowallis, OD
• Scott H Kowallis, O.D.
• Matthew Robert Kresge, PT, DPT
• Sydnee Kunz
• Jason Jerry Larson, M.D.
• George Scott Laub
• Leading Edge Chiropractic, Inc
• Jeffrey Brinkerhoff Luke, RPH
• Suzanne Maddocks, LCSW

• Physician Assistant in Roosevelt, UT
• Providers in Roosevelt, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 13, 2008; 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.