NPIMap

Organization Active NPI

Tahoe Emergency Physicians Medical Corporation

  • Emergency Medicine Physician
  • South Lake Tahoe, CA
National Provider Identifier
1104937408
Registry record updated Jan 2, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
Legal business name
TAHOE EMERGENCY PHYSICIANS MEDICAL CORPORATION
Practice address
2170 South Ave
South Lake Tahoe, CA 96150-7026
Phone
(530) 541-3420
NPI assigned
Aug 31, 2006
Last updated
Jan 2, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 2, 2026

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

Authorized official

Name
Thomas Joseph JantosNPI 1639176415
Title
Ao
Phone
(775) 901-1563

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207P00000X Primary

Addresses

Primary practice location

2170 South Ave
South Lake Tahoe, CA 96150-7026

Mailing address

PO Box 849174
Los Angeles, CA 90084-9174
Phone (775) 901-1563

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20040120000328 CA Part B Supplier - Clinic/Group Practice 0446151674 Receives reassigned benefits from 36 practitioners
Practice locations: South Lake Tahoe, CA; Twin Bridges, CA

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 60

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1767312000000",
    "number": "1104937408",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 849174",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900849174",
            "telephone_number": "775-901-1563"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2170 SOUTH AVE",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961507026",
            "telephone_number": "530-541-3420"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAHOE EMERGENCY PHYSICIANS MEDICAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-31",
        "last_updated": "2026-01-02",
        "certification_date": "2026-01-02",
        "status": "A",
        "authorized_official_last_name": "JANTOS",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "JOSEPH",
        "authorized_official_title_or_position": "AO",
        "authorized_official_telephone_number": "775-901-1563"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "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 Jan 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.