Active NPI
Jason Edward Moore
- Case Manager/Care Coordinator
- South Lake Tahoe, CA
National Provider Identifier
1043979479
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Case Manager/Care Coordinator
- Practice address
- 1900 Lake Tahoe Blvd
South Lake Tahoe, CA 96150-6305 - Phone
- (530) 573-7970
- NPI assigned
- Dec 13, 2021
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | |||
| Case Manager/Care Coordinator | 171M00000X | Primary |
Addresses
Primary practice location
1900 Lake Tahoe Blvd
South Lake Tahoe, CA 96150-6305
Mailing address
1900 Lake Tahoe Blvd
South Lake Tahoe, CA 96150-6305
Phone (530) 573-7970
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1639353600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719187200000",
"number": "1043979479",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1900 LAKE TAHOE BLVD",
"city": "SOUTH LAKE TAHOE",
"state": "CA",
"postal_code": "961506305",
"telephone_number": "530-573-7970"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1900 LAKE TAHOE BLVD",
"city": "SOUTH LAKE TAHOE",
"state": "CA",
"postal_code": "961506305",
"telephone_number": "530-573-7970"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOORE",
"first_name": "JASON",
"middle_name": "EDWARD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-12-13",
"last_updated": "2024-06-24",
"certification_date": "2024-06-24",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Lake Tahoe, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.