Individual provider Active NPI

Jacquelyn Noel Sartorius, PA-C

  • Physician Assistant
  • South Lake Tahoe, CA
National Provider Identifier
1134558000
Registry record updated Aug 27, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
PA52669 Issued in CA
Practice address
2201 South Ave
South Lake Tahoe, CA 96150-7025
Phone
(530) 543-5623
Fax
(530) 541-5738
NPI assigned
Nov 1, 2013
Last updated
Aug 27, 2015By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X PA52669 CA Primary

Addresses

Primary practice location

2201 South Ave
South Lake Tahoe, CA 96150-7025

Mailing address

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

Other names 1

  • Jacquelyn Noel Harris Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NM2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20151005001021 CA Practitioner - Physician Assistant 7315174331 Reassigns benefits to 1 organization
I20211223000950 NM Practitioner - Physician Assistant 7315174331 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare

Merit-based Incentive Payment System (MIPS)

Final score
94.24 of 100Reported as group
Quality
98.74
Improvement activities
40
Cost
83.11

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
PA52669CAMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Tahoe Carson Valley Medical Group Inc CurrentSince Aug 14, 2015 Accepting new patients
Barton Medical Foundation PastSince Jan 1, 2023 Accepting new patients

Locations

1090 3rd St
South Lake Tahoe, CA 96150
Phone (530) 543-5660

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

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

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.

NPI Registry JSON

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

{
    "created_epoch": "1383264000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1440633600000",
    "number": "1134558000",
    "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": "2201 SOUTH AVE",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961507025",
            "telephone_number": "530-543-5623",
            "fax_number": "530-541-5738"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SARTORIUS",
        "first_name": "JACQUELYN",
        "middle_name": "NOEL",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-11-01",
        "last_updated": "2015-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "PA52669",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JACQUELYN",
            "last_name": "HARRIS",
            "middle_name": "NOEL",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in South Lake Tahoe, CA

Sources for this page

Verify at the official NPI Registry.