LARISA BRADFORD LLC
NPI 1629803754
Family Medicine in Gainesville, GA
About Larisa Bradford Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
LARISA BRADFORD LLC (NPI 1629803754) is a healthcare organization registered as a family medicine in Gainesville, Georgia and active in the NPI registry since September 2024. The organization lists Larisa Russell, Owner/medical Doctor, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Group Practice 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Larisa Bradford Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Larisa Bradford LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Larisa Bradford LLC's NPI number?
The NPI number for Larisa Bradford LLC is 1629803754. It was assigned to this organization in the NPPES registry on September 6, 2024.
Where is Larisa Bradford LLC located?
Larisa Bradford LLC is located at 808 Main St SW, Gainesville, GA 30501. The listed phone number is (404) 808-6071.
What is Larisa Bradford LLC's specialty?
The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.
Is Larisa Bradford LLC enrolled in Medicare?
Yes. Larisa Bradford LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Larisa Bradford LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Family Practice) reassigns their Medicare billing to Larisa Bradford LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Larisa Bradford LLC was last updated on January 23, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 21 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Larisa Bradford Llc · NPI 1629803754
Family Medicine organization in Gainesville, Georgia. Organization record, active in the CMS NPPES registry since September 6, 2024.
## Identity
- **NPI:** 1629803754 (Entity type: Organization)
- **Enumerated:** September 6, 2024
- **Primary specialty:** Family Medicine · taxonomy 207Q00000X
- **Organization subpart:** No
- **Authorized official:** Larisa Russell, OWNER/MEDICAL DOCTOR
## Practice location
- **Address:** 808 MAIN ST SW, Gainesville, GA 30501-4472
- **Phone:** (404) 808-6071
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Family Practice) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** January 23, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1629803754) · Data from the CMS NPPES public registry.