Active NPI
Larissa Ivanovna Run, PA-C
- Physician Assistant
- Las Vegas, NV
National Provider Identifier
1225337132
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA1268
- Practice address
- 9701 West Flamingo Rd
#4
Las Vegas, NV 89147 - Phone
- (702) 240-3929
- Fax
- (702) 240-4203
- NPI assigned
- Mar 17, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA1268 | NV | Primary |
| Specialist | 174400000X | PA1268 | NV |
Addresses
Primary practice location
9701 West Flamingo Rd
#4
Las Vegas, NV 89147
Mailing address
9701 West Flamingo Rd
#4
Las Vegas, NV 89147
Phone (702) 240-3929
Other names 1
- Mrs. Larissa Ivanovna Run
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Oct 1, 2022 through Oct 1, 2026
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA1268 | NV | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ageless Men'S Health NV, LLC | Past | Accepting new patients | |
| Total Orthopedics LLC | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Urology Physician
- Las Vegas, NV
- NPI 1023330230
-
- Multi-Specialty Clinic/Center
- Henderson, NV
- NPI 1447495858
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1300320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1728518400000",
"number": "1225337132",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9701 WEST FLAMINGO RD",
"address_2": "#4",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "89147",
"telephone_number": "702-240-3929",
"fax_number": "702-240-4203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9701 WEST FLAMINGO RD",
"address_2": "#4",
"city": "LAS VEGAS",
"state": "NV",
"postal_code": "89147",
"telephone_number": "702-240-3929",
"fax_number": "702-240-4203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUN",
"first_name": "LARISSA",
"middle_name": "IVANOVNA",
"name_prefix": "Mrs.",
"credential": "PA-C",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-03-17",
"last_updated": "2024-10-10",
"certification_date": "2022-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "NV",
"license": "PA1268",
"primary": true
},
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NV",
"license": "PA1268",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "LARISSA",
"last_name": "RUN",
"middle_name": "IVANOVNA",
"prefix": "MRS.",
"credential": "PA-C",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.