Active NPI
Jessica Marie Starr, PA
- Physician Assistant
- South Lake Tahoe, CA
National Provider Identifier
1205145703
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA21280
- Practice address
- 1139 3Rd St
South Lake Tahoe, CA 96150-3465 - Phone
- (530) 541-3000
- Fax
- (530) 541-3016
- NPI assigned
- Sep 30, 2010
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA21280 | CA | Primary |
Addresses
Primary practice location
1139 3Rd St
South Lake Tahoe, CA 96150-3465
Mailing address
1111 Emerald Bay Rd
South Lake Tahoe, CA 96150-6207
Phone (530) 543-5979
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA21280 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1285804800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1287100800000",
"number": "1205145703",
"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": "530-543-5979",
"fax_number": "530-541-8723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1139 3RD ST",
"city": "SOUTH LAKE TAHOE",
"state": "CA",
"postal_code": "961503465",
"telephone_number": "530-541-3000",
"fax_number": "530-541-3016"
}
],
"practiceLocations": [],
"basic": {
"last_name": "STARR",
"first_name": "JESSICA",
"middle_name": "MARIE",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2010-09-30",
"last_updated": "2010-10-15",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA21280",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Lake Tahoe, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.