NPIMap

Organization Active NPI

County of El Dorado

  • Urgent Care Clinic/Center
  • South Lake Tahoe, CA
National Provider Identifier
1730989286
Registry record updated Oct 15, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
COUNTY OF EL DORADO
Practice address
1041 Al Tahoe Blvd.
South Lake Tahoe, CA 96150-4502
Phone
(530) 621-7990
NPI assigned
Mar 14, 2025
Last updated
Oct 15, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 15, 2026

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

Authorized official

Name
Kaci Smith
Title
Chief Probation Officer
Phone
(530) 621-5625

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

1041 Al Tahoe Blvd.
South Lake Tahoe, CA 96150-4502

Mailing address

3974 Durock Rd Ste 205
Shingle Springs, CA 95682-8568
Phone (530) 621-5625

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2143666Wellpath, El Dorado County,1041 Al Tahoe Blvd, South Lake Tahoe, CA 96150Certificate of waiverFeb 1, 2028

National Provider Directory

National Provider Directory
Tax ID family
El Dorado County TCM Program22 organizations share this tax ID, including this one

Other organizations with this tax ID 21

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

View all 21

Locations

3974 Durock Rd
Ste 205
Shingle Springs, CA 95682
Phone (530) 621-4687

1041 Al Tahoe Blvd
South Lake Tahoe, CA 96150
Phone (530) 573-7979

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1741910400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1792022400000",
    "number": "1730989286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3974 DUROCK RD STE 205",
            "city": "SHINGLE SPRINGS",
            "state": "CA",
            "postal_code": "956828568",
            "telephone_number": "530-621-5625"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1041 AL TAHOE BLVD.",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961504502",
            "telephone_number": "530-621-7990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COUNTY OF EL DORADO",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-03-14",
        "last_updated": "2026-10-15",
        "certification_date": "2026-10-15",
        "status": "A",
        "authorized_official_last_name": "SMITH",
        "authorized_official_first_name": "KACI",
        "authorized_official_title_or_position": "CHIEF PROBATION OFFICER",
        "authorized_official_telephone_number": "530-621-5625"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Lake Tahoe, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.