Clinton James Masterson, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

A100433 Issued in CA

Practice address

2170 South Ave
South Lake Tahoe, CA 96150-7026

Phone

(530) 541-3420

NPI assigned

May 24, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 5

Addresses

Other identifiers 2

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NV, MN, CO, TX4 enrollments

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 4

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cmasterson865399@ahs.direct-ci.com

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.

• Team Physicians of Nevada-Scherr, P.C.

  • Emergency Medicine Physician
  • Pleasanton, CA
  • NPI 1073942116

  NV

  Medicare reassignment NPD
• Emergency Associates of Central Texas PA

  • Emergency Medicine Physician
  • Killeen, TX
  • NPI 1215418280
  Medicare reassignment NPD
• Emergency Professionals of Colorado, PC

  • Emergency Medicine Physician
  • Loveland, CO
  • NPI 1396496469
  Medicare reassignment NPD
• Mayo Clinic Health System-Fairmont

  • Multi-Specialty Clinic/Center
  • Fairmont, MN
  • NPI 1366410862
  Medicare reassignment NPD
• Mayo Clinic Health System-Southwest Minnesota Region

  • Critical Access Hospital
  • New Prague, MN
  • NPI 1124035282
  Medicare reassignment NPD
• Mayo Clinic Health System-Southwest Minnesota Region

  • Multi-Specialty Clinic/Center
  • Mankato, MN
  • NPI 1578545422
  Medicare reassignment NPD
• Carson Tahoe Emergency Physicians

  • Emergency Medicine Physician
  • Carson City, NV
  • NPI 1396822821
  NPD
• Emergency Professionals of Colorado, PC

  • Emergency Medicine Physician
  • Greeley, CO
  • NPI 1366835415
  NPD
• Mayo Clinic Health System-Southwest Minnesota Region

  • Multi-Specialty Clinic/Center
  • Waseca, MN
  • NPI 1518494251
  NPD
• Barton Healthcare System

  • Rural Health Clinic/Center
  • South Lake Tahoe, CA
  • NPI 1053310326
  NPD (past)
• Tahoe Emergency Physicians Medical Corporation

  • Emergency Medicine Physician
  • South Lake Tahoe, CA
  • NPI 1104937408
  NPD (past)
• Churchill Mangat Emergency Group PC

  • Emergency Medicine Physician
  • Fallon, NV
  • NPI 1881905149
  NPD (past)

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

{
    "created_epoch": "1179964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603065600000",
    "number": "1407067168",
    "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": "530-543-5652",
            "fax_number": "530-541-8723"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2170 SOUTH AVE",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961507026",
            "telephone_number": "530-541-3420"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "800 Medical Center Dr",
            "address_purpose": "LOCATION",
            "city": "Fairmont",
            "state": "MN",
            "postal_code": "560314575",
            "country_code": "US",
            "telephone_number": "507-238-8100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MASTERSON",
        "first_name": "CLINTON",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-05-24",
        "last_updated": "2020-10-19",
        "certification_date": "2020-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "234413",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CO",
            "license": "44775",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A100433",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NV",
            "license": "12330",
            "primary": false
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "TX",
            "license": "M7408",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407067168",
            "state": "NV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1407067168",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cmasterson67976@ehrdirect.mayoclinicmsg.org",
            "affiliation": "N",
            "address_1": "800 Medical Center Dr",
            "city": "Fairmont",
            "state": "MN",
            "country_code": "US",
            "postal_code": "560314575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Donald Patrick Martin, MD
• Launa Jean Martin, CD, CLE
• Marci Martinelli, M.S.
• Dennis Anthony Martinez, MD
• Chris Wayne Mason
• Ashley Marie Mavon
• Corey A MC Leod, MD
• Tamara McBride, MD
• Morgan Hailey McCauley
• Robin McClary

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2020; 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.