Individual provider Active NPI

Jacob Marquette, DO

  • Family Medicine Physician
  • South Lake Tahoe, CA
National Provider Identifier
1649659772
Registry record updated Apr 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
15073 Issued in CA
Practice address
2170 South Ave
South Lake Tahoe, CA 96150-7026
Phone
(530) 541-3420
NPI assigned
May 21, 2015
Last updated
Apr 28, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 28, 2025

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X DR.0060772 CO
Family Medicine Physician 207Q00000X 15073 CA Primary
Addiction Medicine (Preventive Medicine) Physician 2083A0300X 15073 CA

Addresses

Primary practice location

2170 South Ave
South Lake Tahoe, CA 96150-7026

Mailing address

3291 Loma Vista Rd
Ventura, CA 93003-3099
Phone (805) 652-6100

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO, CA2 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 2

Enrollment IDStateProvider typePAC IDDetails
I20180925002817 CO Practitioner - Family Practice 0345591681
I20200107002797 CA Practitioner - HospitalistPractitioner - Family Practice 0345591681 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lake Erie College of Osteopathic Medicine, Erie, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Barton Healthcare SystemGroup PAC ID 1850293960, 24 clinicians
Barton Medical FoundationGroup PAC ID 5395127682, 97 clinicians

Practice addresses (Care Compare)

2170 S Ave
South Lake Tahoe, CA 96150

2170 S Ave
South Lake Tahoe, CA 96150-7026
Phone (530) 543-5553

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
98.59 of 100Reported as group
Quality
95.23
Promoting interoperability
100
Improvement activities
40

Merit-based Incentive Payment System (MIPS)

Final score
95.71 of 100Reported as apm
Quality
89.85
Promoting interoperability
94.05
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
15073CAMDOptometrist
DR.0060772COMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Barton Healthcare System Family Medicine CurrentSince Nov 4, 2019 Accepting new patients
Barton Healthcare System CurrentSince Nov 4, 2019 Accepting new patients
Tahoe Carson Valley Medical Group Inc Family Medicine CurrentSince Nov 4, 2019 Accepting new patients
Barton Medical Foundation Family Medicine CurrentSince Jan 1, 2023 Accepting new patients
Gunnison Valley Hospital Past Accepting new patients
Tahoe Forest Hospital District Past Accepting new patients

Locations

1090 3rd St
South Lake Tahoe, CA 96150
Phone (530) 543-5660

2074 Lake Tahoe Blvd
Ste 4
South Lake Tahoe, CA 96150
Phone (530) 543-5554

2170 South Ave
South Lake Tahoe, CA 96150
Phone (530) 541-3420

2201 South Ave
South Lake Tahoe, CA 96150
Phone (530) 543-5550

Interoperability endpoints

  • Direct secure messaging: jmarquette152146@direct.renown.org

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 3

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

NPI Registry JSON

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

{
    "created_epoch": "1432166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745798400000",
    "number": "1649659772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3291 LOMA VISTA RD",
            "city": "VENTURA",
            "state": "CA",
            "postal_code": "930033099",
            "telephone_number": "805-652-6100",
            "fax_number": "805-652-3252"
        },
        {
            "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": [],
    "basic": {
        "last_name": "MARQUETTE",
        "first_name": "JACOB",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-05-21",
        "last_updated": "2025-04-28",
        "certification_date": "2025-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CO",
            "license": "DR.0060772",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "15073",
            "primary": true
        },
        {
            "code": "2083A0300X",
            "taxonomy_group": "",
            "desc": "Preventive Medicine, Addiction Medicine",
            "state": "CA",
            "license": "15073",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Lake Tahoe, CA

Sources for this page

Verify at the official NPI Registry.