NPIMap

Individual provider Active NPI

Miriam Locke, MD

  • Urology Physician
  • South Lake Tahoe, CA
National Provider Identifier
1225455157
Registry record updated Jun 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
A162641 Issued in CA
Practice address
2169 South Ave
South Lake Tahoe, CA 96150-7059
Phone
(530) 543-5400
Fax
(530) 213-5241
NPI assigned
Mar 28, 2014
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X A162641 CA Primary

Addresses

Primary practice location

2169 South Ave
South Lake Tahoe, CA 96150-7059

Mailing address

2170 South Ave
South Lake Tahoe, CA 96150-7008
Phone (530) 543-5400

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230317002464 CA Practitioner - Urology 1951645134 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Louisville School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Barton Medical FoundationGroup PAC ID 5395127682, 97 clinicians

Practice addresses (Care Compare)

2169 S Ave
South Lake Tahoe, CA 96150-7059
Phone (530) 543-5400

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Prostate resection14

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A162641CAMDUrology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Northbay Healthcare Group CurrentSince Dec 2, 2022 Accepting new patients
Northbay Healthcare Group CurrentSince Dec 2, 2022 Accepting new patients
Barton Medical Foundation CurrentSince May 21, 2023 Accepting new patients
Northbay Physicians Surgery Center LLC Past Accepting new patients
Tahoe Carson Valley Medical Group Inc Urology Past Accepting new patients

Locations

4500 Business Center Dr
Fairfield, CA 94534
Phone (707) 646-4777

1200 B Gale Wilson Blvd
Fairfield, CA 94533
Phone (707) 429-3600

2169 South Ave
South Lake Tahoe, CA 96150
Phone (530) 543-5400

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

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

2169 South Ave
Ste A
South Lake Tahoe, CA 96150
Phone (530) 541-2804

101 Bodin Cir
Travis AFB, CA 94535
Phone (707) 423-3000

1000 Nut Tree Rd
Vacaville, CA 95687
Phone (707) 446-4000

Interoperability endpoints

  • FHIR API: https://fhir-myrecord.cerner.com/r4/UMZ-Uxn6V9x08sH5gCnG-5yPg9ZX7et6/
  • Direct secure messaging: mlocke194379@direct.renown.org

Organizations & group practices 5

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

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": "1395964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1782259200000",
    "number": "1225455157",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2170 SOUTH AVE",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961507008",
            "telephone_number": "530-543-5400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2169 SOUTH AVE",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961507059",
            "telephone_number": "530-543-5400",
            "fax_number": "530-213-5241"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "LOCKE",
        "first_name": "MIRIAM",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-28",
        "last_updated": "2026-06-24",
        "certification_date": "2026-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "CA",
            "license": "A162641",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Lake Tahoe, CA

Sources for this page

Verify at the official NPI Registry.