NPIMap

Organization Active NPI

Tahoe Carson Valley Medical Group, Inc.

  • Durable Medical Equipment & Medical Supplies
  • Stateline, NV
National Provider Identifier
1124334776
Registry record updated Sep 19, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X
Legal business name
TAHOE CARSON VALLEY MEDICAL GROUP, INC.
Practice address
155 Hwy 50
Stateline, NV 89449-9800
Phone
(775) 589-8900
Fax
(775) 588-7110
NPI assigned
Aug 20, 2010
Last updated
Sep 19, 2012By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 19, 2012

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

Authorized official

Name
Dr. Gregory Walter Bergner, MDNPI 1851398671
Title
President
Phone
(775) 589-8900

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Durable Medical Equipment & Medical Supplies 332B00000X Primary

Addresses

Primary practice location

155 Hwy 50
Stateline, NV 89449-9800

Mailing address

1111 Emerald Bay Rd
South Lake Tahoe, CA 96150-6207
Phone (530) 543-5659

Other names 1

  • DME-Stateline Medical Center Other name

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 10

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.

NPI Registry JSON

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

{
    "created_epoch": "1282262400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348012800000",
    "number": "1124334776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 EMERALD BAY RD",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961506207",
            "telephone_number": "530-543-5659",
            "fax_number": "530-541-8723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "155 HWY 50",
            "city": "STATELINE",
            "state": "NV",
            "postal_code": "894499800",
            "telephone_number": "775-589-8900",
            "fax_number": "775-588-7110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAHOE CARSON VALLEY MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-20",
        "last_updated": "2012-09-19",
        "status": "A",
        "authorized_official_last_name": "BERGNER",
        "authorized_official_first_name": "GREGORY",
        "authorized_official_middle_name": "WALTER",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "775-589-8900",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DME-Stateline Medical Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Stateline, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.