North Lake Pediatrics Medical Group, Inc.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

G35475 Issued in CA

Legal business name

NORTH LAKE PEDIATRICS MEDICAL GROUP, INC.

Practice address

10956 Donner Pass Rd Ste 130
Truckee, CA 96161-4860

Phone

(530) 587-3523

Fax

(530) 587-1004

NPI assigned

Oct 18, 2006

Organization subpart

No

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

Authorized official

Name

Ms. Christine Jacobs, M.A.C.M.O.M.

Title

Office Manager

Phone

(530) 582-6190

Specialties & licenses 1

Addresses

Other identifiers 3

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

{
    "created_epoch": "1161129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1700967460",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10956 DONNER PASS RD STE 130",
            "city": "TRUCKEE",
            "state": "CA",
            "postal_code": "961614860",
            "telephone_number": "530-587-3523",
            "fax_number": "530-587-1004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10956 DONNER PASS RD STE 130",
            "city": "TRUCKEE",
            "state": "CA",
            "postal_code": "961614860",
            "telephone_number": "530-587-3523",
            "fax_number": "530-587-1004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTH LAKE PEDIATRICS MEDICAL GROUP, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-18",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "JACOBS",
        "authorized_official_first_name": "CHRISTINE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "530-582-6190",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "M.A.C.M.O.M."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G35475",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0075020",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS PROVIDER NUMBE",
            "identifier": "ZHCPP486",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD PROVIDER #",
            "identifier": "ZZZ52949Z",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Nguyen Chew
• Mai Phuong Thuy Nguyen, MD
• Eric Nickel
• Darcy Dean Norman, PT, ATC, CSCS
• Joseph Norris, BOCO
• North Tahoe Orthopedics
• North Tahoe Radiology Medical Group Inc
• Allison Lindsey O'Brien, PA-C
• Kristin O'Connor, LCSW
• Antoinette Eva Oberriter, PHARMD

• Pediatrics Physician in Truckee, CA
• Providers in Truckee, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.