Active NPI
Beau Larson
- Physician Assistant
- Missoula, MT
National Provider Identifier
1932087665
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- MED-PAC-LIC-164422
- Practice address
- 500 W Broadway St Ste 320
Missoula, MT 59802-4003 - Phone
- (406) 329-5615
- NPI assigned
- Aug 21, 2025
- Sex
- Male
- Sole proprietor
- Yes
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 | MED-PAC-LIC-164422 | MT | Primary |
Addresses
Primary practice location
500 W Broadway St Ste 320
Missoula, MT 59802-4003
Mailing address
PO Box 31001
Pasadena, CA 91110-4110
Phone (406) 329-5615
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MT
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260102001887 | MT | Practitioner - Physician Assistant | 9335635994 | Reassigns benefits to 1 organization |
Care Compare profile
Medicare Care Compare- Specialty
- Physician Assistant
- Education
- Other, 2025
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
Practice addresses (Care Compare)
500 W Broadway St
Suite 320
Missoula, MT 59802-4003
Phone (406) 329-5615
Hospital & facility affiliations
- St. Patrick Hospital
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MED-PAC-LIC-164422 | MT | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Providence Health & Services Mt | Current | Accepting new patients | |
| Providence Health & Services Mt | Current | Accepting new patients | |
| Providence Health & Services Mt | Past | Accepting new patients |
Locations
500 W Broadway St
Ste 320
Missoula, MT 59802
Phone (406) 329-2945
Organizations & group practices 4
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.
-
- Family Medicine Physician
- Missoula, MT
- NPI 1215222617
-
- Obstetrics & Gynecology Physician
- Missoula, MT
- NPI 1417198243
-
- Pulmonary Disease Physician
- Missoula, MT
- NPI 1427096585
Hospital & facility affiliations 4
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Anatomic Pathology & Clinical Pathology Physician
- Missoula, MT
- NPI 1366185928
Hospital
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1755734400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1765238400000",
"number": "1932087665",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 31001",
"city": "PASADENA",
"state": "CA",
"postal_code": "911104110",
"telephone_number": "406-329-5615"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "500 W BROADWAY ST STE 320",
"city": "MISSOULA",
"state": "MT",
"postal_code": "598024003",
"telephone_number": "406-329-5615"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LARSON",
"first_name": "BEAU",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-08-21",
"last_updated": "2025-12-09",
"certification_date": "2025-12-09",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "MT",
"license": "MED-PAC-LIC-164422",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Missoula, MT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2025; 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.