Bradley J. G. Larson, MD

Primary specialty

Hematology & Oncology PhysicianTaxonomy code 207RH0003X

License

054449 Issued in GA

Practice address

157 Clinic Ave
Ste 101
Carrollton, GA 30117-4413

Phone

(770) 333-2220

Fax

(678) 581-7180

NPI assigned

Jun 13, 2005

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in GA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Hematology/Oncology

Education

University of Wisconsin School of Medicine, 1997

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Tanner Oncology Services IncGroup PAC ID 0345670386, 5 clinicians

TMG Northwest Georgia Oncology Center IncGroup PAC ID 8325479918, 8 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tanner Medical Center Villa Rica Hospital, Villa Rica, GA, CCN 110015
• Tanner Medical Center - Carrollton Hospital, Carrollton, GA, CCN 110011
• Higgins General Hospital Hospital, Bremen, GA, CCN 111320
• Tanner Medical Center-East Alabama Hospital, Wedowee, AL, CCN 011306

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

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.

• Tanner Oncology Services Inc

  • Medical Oncology Physician
  • Carrollton, GA
  • NPI 1710515184
  Medicare reassignment Care Compare group NPD
• TMG Northwest Georgia Oncology Center Inc

  • Medical Oncology Physician
  • Villa Rica, GA
  • NPI 1932728326
  Medicare reassignment Care Compare group NPD

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

• Tanner Medical Center, Inc

  • General Acute Care Hospital
  • Carrollton, GA
  • NPI 1801883780
  Care Compare affiliation
• TMC/Higgins General Hospital

  • Critical Access Hospital
  • Bremen, GA
  • NPI 1194712083
  Care Compare affiliation
• TMC/Villa Rica Hospital, Inc

  • General Acute Care Hospital
  • Villa Rica, GA
  • NPI 1851388748
  Care Compare affiliation
• Tanner Medical Center Alabama Inc

  • Critical Access Hospital
  • Wedowee, AL
  • NPI 1912428301
  Care Compare affiliation

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

{
    "created_epoch": "1118620800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1513123200000",
    "number": "1194729582",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "531 ROSELANE ST NW STE 710",
            "city": "MARIETTA",
            "state": "GA",
            "postal_code": "300606975",
            "telephone_number": "678-331-3297",
            "fax_number": "678-581-7187"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "157 CLINIC AVE",
            "address_2": "STE 101",
            "city": "CARROLLTON",
            "state": "GA",
            "postal_code": "301174413",
            "telephone_number": "770-333-2220",
            "fax_number": "678-581-7180"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LARSON",
        "first_name": "BRADLEY",
        "middle_name": "J. G.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-13",
        "last_updated": "2017-12-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "GA",
            "license": "054449",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI NUMBER",
            "identifier": "1194729582",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "009950455",
            "state": "AL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "184142314B",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "184142314A",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "184142314C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Paige Diane Lambert, M.A., CCC-A
• Tiffany Landry
• Guy Harris Langlo, DPM
• Amy Rogers Lanier, MASTERS IN SPEECH LA
• Alexis Lanning
• Laura Lamb Larson, MD
• Megan Latimer
• Lauri Shedd Therapy Services LLC
• Kathleen Jane Layman, NP
• Peter Gary Lazarnick, D.C.

• Hematology & Oncology Physician in Carrollton, GA
• Providers in Carrollton, GA by specialty
• Hematology & Oncology Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2017; 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.