Larissa N Botcharnikova, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA17636 Issued in CA

Practice address

4215 Front St
Shasta Lake, CA 96019-9430

Phone

(530) 246-5710

Fax

(530) 241-7838

NPI assigned

Feb 19, 2007

Last updated

Sep 15, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

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

Medicare enrollment (NPD)

Enrolled

Interoperability endpoints

• Direct secure messaging: larissa.botcharnikovapa.p1@direct.schc.nextgenshare.com

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

{
    "created_epoch": "1171843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1789430400000",
    "number": "1720122054",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 992790",
            "city": "REDDING",
            "state": "CA",
            "postal_code": "960992790",
            "telephone_number": "530-246-5710",
            "fax_number": "530-241-7838"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4215 FRONT ST",
            "city": "SHASTA LAKE",
            "state": "CA",
            "postal_code": "960199430",
            "telephone_number": "530-246-5710",
            "fax_number": "530-241-7838"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BOTCHARNIKOVA",
        "first_name": "LARISSA",
        "middle_name": "N",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-19",
        "last_updated": "2026-09-15",
        "certification_date": "2026-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA17636",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Diane E Allen, D.D.S.
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• Erin Marie Baas, PT
• Wayne Bann
• Lauren M Bishop, MED, BCBA
• Nichole Amber Lee Brandon, LCSW
• Harold S. Budhram, M.D
• Katie Bullock, LMFT
• Tracy Daniel Campbell, CAS
• Cloe Jay Carpenter

• Physician Assistant in Shasta Lake, CA
• Providers in Shasta Lake, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 15, 2026; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.