Jonathan Taylor Hagen, MD
Individual provider Active NPI Orthopaedic Surgery Physician · Zephyr Cove, NV
NPI 1487915153 · NPPES record last updated Jul 21, 2022
Key facts
- NPI
- 1487915153
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Orthopaedic Surgery Physician 207X00000X
- License
- 17021 (NV)
- Practice address
- 212 Elks Point Rd Ste 200
Zephyr Cove, NV 89448-8001 - Phone
- (775) 589-8950
- Fax
- (775) 588-1299
- NPI assigned
- May 30, 2012
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 16
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Orthopedic Surgery
- Education
- Texas a & M University System, HSC, College of Medicine, 2012
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Tahoe Forest Hospital District
Practice addresses (Care Compare)
10051 Lake Ave
Suite 3
Truckee, CA 96161-4870
Phone (530) 587-7461
Hospital & facility affiliations
- Tahoe Forest Hospital
- Eastern Plumas Hospital - Portola Campus
- Incline Village Community Hospital
- Plumas District Hospital
Merit-based Incentive Payment System (MIPS)
- Final score
- 75.06 of 100
- Quality
- 83.97
- Promoting interoperability
- 88
- Improvement activities
- 40
- Cost
- 42.89
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Hip replacement | 14 |
| Knee replacement | 1-10 |
| Lower limb (leg) arthroscopy (minimally invasive joint repair) | 1-10 |
| Upper limb (arm) arthroscopy (minimally invasive joint repair) | 18 |
| Removal of tissue | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA, NV
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170823000104 | CA | Practitioner - Orthopedic Surgery | 3577864503 | Reassigns benefits to 2 organizations |
| I20170824000433 | NV | Practitioner - Orthopedic Surgery | 3577864503 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A148997 | CA | MD | Orthopaedic Surgery Physician |
| 17021 | NV | MD | Orthopaedic Surgery Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tahoe Forest Hospital District | Current |
Accepting new patients | |
| Tahoe Orthopedics & Sports Medicine, Inc. | Orthopaedic Surgery | Current |
Accepting new patients |
| Tahoe Forest Hospital District | Current | Accepting new patients | |
| Lake Tahoe Orthopaedic Institute a Watson-Swanson Professional Corp | Current |
Accepting new patients | |
| Tahoe Forest Hospital District | Orthopaedic Surgery | Current |
Accepting new patients |
| Tahoe Forest Hospital District | Current | Accepting new patients | |
| Lake Tahoe Orthopaedic Institute, a Watson-Swanson Professional Corp | Orthopaedic Surgery | Current |
Accepting new patients |
| Tahoe Forest Hospital District | Past | Accepting new patients |
Locations
1111 Emerald Bay Rd
South Lake Tahoe, CA 96150
Phone (530) 543-5659
2170 South Ave
South Lake Tahoe, CA 96150
Phone (530) 541-3420
1139 3rd St
South Lake Tahoe, CA 96150
Phone (530) 541-3100
10956 Donner Pass Rd
Ste 230
Truckee, CA 96161
Phone (530) 582-3277
10051 Lake Ave
Ste 3
Truckee, CA 96161
Phone (530) 587-7461
935 Mica Dr
Ste 13
Carson City, NV 89705
Phone (775) 783-3065
880 Alder Ave
Fl Second
Incline Vlg, NV 89451
Phone (775) 831-5308
212 Elks Point Rd
Unit 201
Zephyr Cove, NV 89448
Phone (775) 588-9188
Interoperability endpoints
- jhagen995233@directa.mercy.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthopaedic Surgery Physician | 207X00000X | A148997 | CA | |
| Orthopaedic Surgery Physician | 207X00000X | 17021 | NV | Yes |
Addresses
Primary practice location
212 Elks Point Rd Ste 200
Zephyr Cove, NV 89448-8001
Mailing address
1111 Emerald Bay Rd
South Lake Tahoe, CA 96150-6207
Phone (530) 543-5659
Other practice location 1
935 Mica Dr Ste 13
Carson City, NV 89705-7181
Phone (775) 783-3065
Other practice location 2
1139 3rd St
South Lake Tahoe, CA 96150-3465
Phone (530) 543-5554
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200445860A | Medicaid | OK |
Other providers in Zephyr Cove, NV
- Linda Brockman
- Diana L. Brown
- Robert Francis Desipio Jr.
- Elizabeth Erin Eisenlohr
- Christina Chandra Frohlich
- Innovative Dental Solutions, LLC
- Nicholas Kallas
- Lake Tahoe Orthopaedic Institute
- Lake Tahoe Orthopaedic Institute, a Watson-Swanson Professional Corp
- Richard Eldred Lusby
All providers in Zephyr Cove, NV · Orthopaedic Surgery Physician in Nevada
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.