NPIMap

Individual provider Active NPI

John M Watson, MD

  • Internal Medicine Physician
  • Reno, NV
National Provider Identifier
1366460347
Registry record updated Oct 20, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
11947 Issued in NV
Practice address
5575 Kietzke LN
Reno, NV 89511-2290
Phone
(775) 851-1505
Fax
(775) 851-1583
NPI assigned
Jul 17, 2006
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 20, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 11947 NV Primary

Addresses

Primary practice location

5575 Kietzke LN
Reno, NV 89511-2290

Mailing address

2345 E Prater Way Ste 207
Sparks, NV 89434-9634
Phone (775) 851-1505

Other identifiers 2

IdentifierTypeStateIssuer
11614959OtherCAQH
1366460347MedicaidNV

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NV
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
I20061117000185 NV Practitioner - Internal Medicine 6608874144 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Nevada School of Medicine, 2003
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Northern Nevada Medical Group LLCGroup PAC ID 7214093020, 83 clinicians

Practice addresses (Care Compare)

2385 E Prater Way
Suite 205
Sparks, NV 89434-9688
Phone (775) 356-4888

Hospital & facility affiliations

  • Eden Home Health Home health agency, Reno, NV, CCN 297035
  • Renown Health Home Care Home health agency, Reno, NV, CCN 297015
  • Centerwell Home Health Home health agency, Reno, NV, CCN 297022
  • Northern Nevada Medical Center Hospital, Sparks, NV, CCN 290032
  • Renown Regional Medical Center Hospital, Reno, NV, CCN 290001
  • Renown South Meadows Medical Center Hospital, Reno, NV, CCN 290049
  • Saint Mary'S Regional Medical Center Hospital, Reno, NV, CCN 290009

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mt Grant General Hospital Past Accepting new patients
Prime Healthcare Services - Reno LLC Past Accepting new patients
Sparks Family Hospital Inc Past Accepting new patients
South Lyon Health Center, Inc. Past Accepting new patients

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 15

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 15

NPI Registry JSON

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

{
    "created_epoch": "1153094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603152000000",
    "number": "1366460347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2345 E PRATER WAY STE 207",
            "city": "SPARKS",
            "state": "NV",
            "postal_code": "894349634",
            "telephone_number": "775-851-1505",
            "fax_number": "775-851-1583"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5575 KIETZKE LN",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895112290",
            "telephone_number": "775-851-1505",
            "fax_number": "775-851-1583"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATSON",
        "first_name": "JOHN",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-17",
        "last_updated": "2020-10-20",
        "certification_date": "2020-10-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "11947",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "11614959",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1366460347",
            "state": "NV"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Reno, NV

Sources for this page

Verify at the official NPI Registry.