Mountain Meadows Medical Group of California, Inc.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

Legal business name

MOUNTAIN MEADOWS MEDICAL GROUP OF CALIFORNIA, INC.

Practice address

973 Mica Dr Ste 200
Carson City, NV 89705-7258

Phone

(775) 267-6700

Fax

(775) 267-6609

NPI assigned

Nov 16, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Kris F Kobalter, MD

Title

Vice President

Phone

(530) 543-5710

Specialties & licenses 1

Addresses

Other names 1

• Tahoe Women's Care Doing business as

Medicare fee-for-service enrollment

Enrolled in NV

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Mountain Meadows Medical Group of California, Inc.

  • Obstetrics & Gynecology Physician
  • S Lake Tahoe, CA
  • NPI 1972630432

  5597750349

  Same PAC ID

Tax ID family

Mountain Meadows Med GRP2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mountain Meadows Medical Group of California, Inc.

  • Obstetrics & Gynecology Physician
  • S Lake Tahoe, CA
  • NPI 1972630432
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Gary F Willen, MD

  • Obstetrics & Gynecology Physician
  • Carson City, NV
  • NPI 1700857422
  Medicare reassignment NPD

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

{
    "created_epoch": "1195171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348012800000",
    "number": "1497936694",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1067 4TH ST",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961503459",
            "telephone_number": "530-543-5710",
            "fax_number": "530-542-1455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "973 MICA DR STE 200",
            "city": "CARSON CITY",
            "state": "NV",
            "postal_code": "897057258",
            "telephone_number": "775-267-6700",
            "fax_number": "775-267-6609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN MEADOWS MEDICAL GROUP OF CALIFORNIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-16",
        "last_updated": "2012-09-19",
        "status": "A",
        "authorized_official_last_name": "KOBALTER",
        "authorized_official_first_name": "KRIS",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "530-543-5710",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Obstetrics & Gynecology",
            "state": "NV",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tahoe Women's Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Melisse Knoll Morrison, M.S.CCC-SLP
• Sara Morrison, R.D, L.D
• Jami Mosbacher
• Susan Moseley
• Mark J Mosely, CADTP3
• Mountain Springs Assisted Living
• Mountain West Anesthesia
• Khosrow Movahedi, D.D.S.
• MPS Dental LLC
• Melissa Eleonor Mulder

• Obstetrics & Gynecology Physician in Carson City, NV
• Providers in Carson City, NV by specialty
• Obstetrics & Gynecology Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.