Active NPI
Kylie Larsen
- Physician Assistant
- Quincy, MA
National Provider Identifier
1780494278
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA102504
- Practice address
- 9 Bicknell St
Quincy, MA 02169-6562 - Phone
- (617) 376-3000
- NPI assigned
- Jan 8, 2025
- Last updated
- Mar 30, 2026
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA102504 | MA | Primary |
Addresses
Primary practice location
9 Bicknell St
Quincy, MA 02169-6562
Mailing address
9 Bicknell St
Quincy, MA 02169-6562
Phone (617) 376-3000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2025
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
110 W Squantum St
Quincy, MA 02171-2122
1461 Crestview Rd
Redlands, CA 92374-6341
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA102504 | MA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1736294400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1774828800000",
"number": "1780494278",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9 BICKNELL ST",
"city": "QUINCY",
"state": "MA",
"postal_code": "021696562",
"telephone_number": "617-376-3000"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9 BICKNELL ST",
"city": "QUINCY",
"state": "MA",
"postal_code": "021696562",
"telephone_number": "617-376-3000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSEN",
"first_name": "KYLIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-01-08",
"last_updated": "2026-03-30",
"certification_date": "2026-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MA",
"license": "PA102504",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Quincy, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2026; 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.