NPIMap

Individual provider Active NPI

Leonard Peter Holmgren, MD

  • Diagnostic Radiology Physician
  • S Lake Tahoe, CA
National Provider Identifier
1114906088
Registry record updated Aug 5, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
G86132 Issued in CA
Practice address
2170 South Ave
S Lake Tahoe, CA 96150-7026
Phone
(530) 543-5850
Fax
(530) 542-9550
NPI assigned
Jan 10, 2006
Last updated
Aug 5, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 9846 NV
Diagnostic Radiology Physician 2085R0202X G86132 CA Primary

Addresses

Primary practice location

2170 South Ave
S Lake Tahoe, CA 96150-7026

Mailing address

PO Box 19879
Reno, NV 89511-2533
Phone (888) 480-6640

Other identifiers 4

IdentifierTypeStateIssuer
1114906088MedicaidNV
300127927OtherNVRAILROAD MEDICARE
300127929OtherCARAILROAD MEDICARE
1114906088MedicaidCA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV, CA2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20110127000743 NV Practitioner - Diagnostic Radiology 8022168475 Reassigns benefits to 1 organization
I20260420001134 CA Practitioner - Diagnostic Radiology 8022168475 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Tufts University School of Medicine, 1994
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Sierra Nevada Medical ImagingGroup PAC ID 2466430475, 5 clinicians

Practice addresses (Care Compare)

1107 US Hwy 395 N
Gardnerville, NV 89410-5304
Phone (775) 782-1500

2170 S Ave
South Lake Tahoe, CA 96150-7026
Phone (530) 541-3420

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
97.36 of 100Reported as group
Quality
94.72
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
96.42 of 100Reported as group
Quality
93.48
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
9846NVMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Colorado Imaging Associates P C Diagnostic Radiology Past Accepting new patients
Denver NMR, Inc Past Accepting new patients

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1136851200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407196800000",
    "number": "1114906088",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 19879",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895112533",
            "telephone_number": "888-480-6640",
            "fax_number": "775-852-6902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2170 SOUTH AVE",
            "city": "S LAKE TAHOE",
            "state": "CA",
            "postal_code": "961507026",
            "telephone_number": "530-543-5850",
            "fax_number": "530-542-9550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HOLMGREN",
        "first_name": "LEONARD",
        "middle_name": "PETER",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-10",
        "last_updated": "2014-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NV",
            "license": "9846",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "G86132",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114906088",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "300127927",
            "state": "NV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "300127929",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1114906088",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in S Lake Tahoe, CA

Sources for this page

Verify at the official NPI Registry.