NPIMap

Individual provider Active NPI

Matthew Paul Wonnacott, MD

  • Family Medicine Physician
  • South Lake Tahoe, CA
National Provider Identifier
1144214495
Registry record updated Jul 21, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A64012 Issued in CA
Practice address
2201 South Ave
South Lake Tahoe, CA 96150-7025
Phone
(530) 543-5623
Fax
(530) 541-5738
NPI assigned
Sep 1, 2005
Last updated
Jul 21, 2022By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 21, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A64012 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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA, NV2 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
I20170522002601 CA Practitioner - Family Practice 5496067423 Reassigns benefits to 2 organizations
I20241210004874 NV Practitioner - Family Practice 5496067423 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Barton Medical FoundationGroup PAC ID 5395127682, 97 clinicians

Practice addresses (Care Compare)

1108 4TH St
South Lake Tahoe, CA 96150-3476
Phone (530) 543-5750

155 Hwy 50
Stateline, NV 89449-9816
Phone (775) 589-8900

2074 Lake Tahoe Blvd
Suite 4
South Lake Tahoe, CA 96150-6408
Phone (530) 543-5554

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.71 of 100Reported as apm
Quality
89.85
Promoting interoperability
94.05
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal of nail tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A64012CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Tahoe Carson Valley Medical Group Inc Family Medicine CurrentSince Jun 1, 2017 Accepting new patients
Barton Medical Foundation Family Medicine CurrentSince 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

2074 Lake Tahoe Blvd
Ste 4
South Lake Tahoe, CA 96150
Phone (530) 543-5554

2092 Lake Tahoe Blvd
Ste 500
South Lake Tahoe, CA 96150
Phone (530) 543-5581

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

Interoperability endpoints

  • Direct secure messaging: mwonnacott117496@direct.renown.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Barton Memorial HospitalSouth Lake Tahoe, CA, CCN 555698 Skilled nursing facility Operational/Managerial Control
Adp of the SNF		 Jun 1, 2023
Jun 1, 2023

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 2

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": "1125532800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1144214495",
    "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": "WONNACOTT",
        "first_name": "MATTHEW",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-01",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A64012",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Lake Tahoe, CA

Sources for this page

Verify at the official NPI Registry.