Tahoe Emergency Physicians Medical Corporation
Organization Active NPI Emergency Medicine Physician · South Lake Tahoe, CA
NPI 1104937408 · NPPES record last updated Jan 2, 2026
Key facts
- NPI
- 1104937408
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emergency Medicine Physician 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
- Organization subpart
- No
Authorized official
- Name
- Thomas Joseph Jantos
- Title
- Ao
- Phone
- (775) 901-1563
Practitioners 60
-
Ryan W Horton, MD
-
Corey A MC Leod, MD
-
Trisha Raz, M.D.
-
Shunei Asao, MD
-
Brett Bailey, D.O
-
John T Elliott, M.D.
-
Nathan Furst-Nichols, M.D.
-
Daniel Shocket, MD
-
Paul Aaron Garrett, D.O.
-
Amy Pape Anton, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CA
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| GR0086240 | Medicaid | CA |
Other providers in South Lake Tahoe, CA
- Allyson Maria Tabor
- Tahoe Basin Behavior Analysis, LLC
- Tahoe Carson Valley Medical Group Inc
- Tahoe Carson Valley Medical Group Inc
- Tahoe Coalition for the Homeless
- Tahoe Family Hearing Clinic, PC
- Tahoe Orthopedics & Sports Medicine, Inc.
- Tahoe Orthopedics and Sports Medicine, Inc
- Tahoe Turning Point
- Tahoe Turning Point
All providers in South Lake Tahoe, CA · Emergency Medicine Physician in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 2, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.