Active NPI
Jan Ronald Johnson, PT
- Physical Therapist
- South Lake Tahoe, CA
National Provider Identifier
1295784510
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- 6891
- Practice address
- 2249 Sierra House TRL
South Lake Tahoe, CA 96150-6830 - Phone
- (530) 542-5750
- Fax
- (530) 542-5752
- NPI assigned
- May 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Physical Therapist | 225100000X | 6891 | CA | Primary |
Addresses
Primary practice location
2249 Sierra House TRL
South Lake Tahoe, CA 96150-6830
Mailing address
2249 Sierra House TRL
South Lake Tahoe, CA 96150-6830
Phone (530) 542-5750
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20120215000330 | CA | Practitioner - Physical Therapist in Private Practice | 8022276484 | Practice locations: South Lake Tahoe, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Physical Therapist in Private Practice
- Education
- Other, 1974
- Medicare assignment
- May accept Medicare assignment
Practice addresses (Care Compare)
South Lake Tahoe, CA 96150
Phone (530) 542-5750
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6891 | CA | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146873600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1752451200000",
"number": "1295784510",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2249 SIERRA HOUSE TRL",
"city": "SOUTH LAKE TAHOE",
"state": "CA",
"postal_code": "961506830",
"telephone_number": "530-542-5750",
"fax_number": "530-542-5752"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2249 SIERRA HOUSE TRL",
"city": "SOUTH LAKE TAHOE",
"state": "CA",
"postal_code": "961506830",
"telephone_number": "530-542-5750",
"fax_number": "530-542-5752"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "JAN",
"middle_name": "RONALD",
"name_prefix": "Mr.",
"credential": "PT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-06",
"last_updated": "2025-07-14",
"certification_date": "2025-07-14",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "6891",
"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 Jul 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.