Michael Phillip Doyle, MEDICAL DOCTOR

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

G71419 Issued in CA

Practice address

2074 Lake Tahoe Blvd
Ste 9
South Lake Tahoe, CA 96150-6407

Phone

(530) 541-6100

Fax

(530) 541-5945

NPI assigned

Jun 28, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mdoyle87449@direct.renown.org

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.

• Northern Inyo Healthcare District

  • Critical Access Hospital
  • Bishop, CA
  • NPI 1922198712
  Medicare reassignment NPD
• Northern Inyo Healthcare District

  • Medicare Defined Swing Bed Hospital Unit
  • Bishop, CA
  • NPI 1669798815
  NPD
• Barton Healthcare System

  • General Acute Care Hospital
  • South Lake Tahoe, CA
  • NPI 1003867565
  NPD (past)

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

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736467200000",
    "number": "1265460463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2074 LAKE TAHOE BLVD",
            "address_2": "STE 9",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961506407",
            "telephone_number": "530-541-6100",
            "fax_number": "530-541-5945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2074 LAKE TAHOE BLVD",
            "address_2": "STE 9",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961506407",
            "telephone_number": "530-541-6100",
            "fax_number": "530-541-5945"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "152 Pioneer Ln Ste H",
            "address_purpose": "LOCATION",
            "city": "Bishop",
            "state": "CA",
            "postal_code": "935142563",
            "country_code": "US",
            "telephone_number": "760-873-6373",
            "fax_number": "760-873-3266",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "DOYLE",
        "first_name": "MICHAEL",
        "middle_name": "PHILLIP",
        "name_prefix": "Dr.",
        "credential": "MEDICAL DOCTOR",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2025-01-10",
        "certification_date": "2025-01-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G71419",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0005620",
            "state": "CA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "002085724",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Casey Donahue
• Justin Brent Dorn, DPT
• Douglas W. Mundy
• Molly Dowd
• William Arthur Downey, OD
• Elizabeth Drabant
• Cheryl Drake, L.AC.
• Drew Nicolas Dunbar
• Timothy R Durkin, D.D.S.
• Dustin Kieschnick, PSYD

• Pediatrics Physician in South Lake Tahoe, CA
• Providers in South Lake Tahoe, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.