Individual provider Active NPI

Marielle Chloe Aline Larsen, PA-C

  • Physician Assistant
  • Moses Lake, WA
National Provider Identifier
1861182503
Registry record updated Feb 12, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA.PA.61631353 Issued in WA
Practice address
605 S Coolidge St
Moses Lake, WA 98837-1873
Phone
(435) 557-6842
NPI assigned
May 8, 2023
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 12, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA.PA.61631353 WA Primary

Addresses

Primary practice location

605 S Coolidge St
Moses Lake, WA 98837-1873

Mailing address

650 N 600 E
Provo, UT 84606-1912

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WA
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
I20250318001261 WA Practitioner - Physician Assistant 1254852940 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

605 S Coolidge St
Moses Lake, WA 98837-1893
Phone (509) 765-0674

Hospital & facility affiliations

  • Samaritan Hospital Hospital, Moses Lake, WA, CCN 500033

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
PA.PA.61631353WAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Moses Lake Community Health Center CurrentSince Feb 3, 2025 Accepting new patients
Moses Lake Community Health Center CurrentSince Feb 3, 2025 Accepting new patients
Moses Lake Community Health Center Past Accepting new patients

Locations

605 S Coolidge St
Moses Lake, WA 98837
Phone (509) 765-0674

605 S Coolidge St
#101
Moses Lake, WA 98837
Phone (509) 765-0674

Organizations & group practices 3

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.

Hospital & facility affiliations 1

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": "1683504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1739318400000",
    "number": "1861182503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 N 600 E",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846061912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "605 S COOLIDGE ST",
            "city": "MOSES LAKE",
            "state": "WA",
            "postal_code": "988371873",
            "telephone_number": "435-557-6842"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSEN",
        "first_name": "MARIELLE",
        "middle_name": "CHLOE ALINE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-05-08",
        "last_updated": "2025-02-12",
        "certification_date": "2025-02-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA.PA.61631353",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moses Lake, WA

Sources for this page

Verify at the official NPI Registry.