Brennen Larsen, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

6141 Issued in AZ

Practice address

21 Winn Dr
Rexburg, ID 83440-5277

Phone

(208) 881-5222

Fax

(877) 441-4715

NPI assigned

Sep 17, 2015

Sex

Male

Sole proprietor

Yes

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, 2015

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Fall River Medical PLLCGroup PAC ID 4981846698, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Madison Memorial Hospital Hospital, Rexburg, ID, CCN 130025

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: larsenbr@direct.madisonmemorial.org

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.

• Fall River Medical, PLLC

  • Primary Care Clinic/Center
  • Rexburg, ID
  • NPI 1457698987
  Medicare reassignment Care Compare group
• Madison Co Memorial Hospital

  • General Acute Care Hospital
  • Rexburg, ID
  • NPI 1992747570
  NPD
• Madison Co Memorial Hospital

  • Family Medicine Physician
  • Rigby, ID
  • NPI 1356026280
  NPD (past)

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

• Madison Co Memorial Hospital

  • Obstetrics & Gynecology Physician
  • Rexburg, ID
  • NPI 1073154266

  Hospital

  Care Compare affiliation
• Madison Co Memorial Hospital

  • General Acute Care Hospital
  • Rexburg, ID
  • NPI 1992747570
  Care Compare affiliation

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

{
    "created_epoch": "1442448000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1574121600000",
    "number": "1740659010",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "21 WINN DR",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834405277",
            "telephone_number": "208-881-5222",
            "fax_number": "887-441-4715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 WINN DR",
            "city": "REXBURG",
            "state": "ID",
            "postal_code": "834405277",
            "telephone_number": "208-881-5222",
            "fax_number": "877-441-4715"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "BRENNEN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2015-09-17",
        "last_updated": "2019-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "6141",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Fabiola Koperberg, MS
• Kylin Kovac DPM PLLC
• Carol Ladle, F.N.P.-C
• Aileen Lai
• Lake Thompson Counseling
• Emily Larson, LMT
• Michael J Larson, MD
• Jarrod Kieth Laub, LAMFT
• LDS Family Services
• Bryan D Lee, DDS, MD

• Physician Assistant in Rexburg, ID
• Providers in Rexburg, ID by specialty
• Physician Assistant in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2019; 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.