Active NPI
Christopher S Proctor, PT
- Physical Therapist
- South Lake Tahoe, CA
National Provider Identifier
1750372116
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapist
- License
- PT22738
- Practice address
- 1139 3Rd St
South Lake Tahoe, CA 96150-3465 - Phone
- (530) 541-3100
- Fax
- (530) 541-3016
- NPI assigned
- Nov 3, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapist | 225100000X | PT22738 | CA | Primary |
| Physical Therapist | 225100000X | 1203 | NV |
Addresses
Primary practice location
1139 3Rd St
South Lake Tahoe, CA 96150-3465
Mailing address
PO Box 529
Zephyr Cove, NV 89448-0529
Phone (775) 588-8938
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| P00211696 | Other | CA | MEDICARE RAILROAD |
| CC7486 | Other | NV | BCBS |
| PT0227380 | Other | CA | MEDI-CAL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1203 | NV | MD | Optometrist |
| PT22738 | CA | MD | Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Barton Healthcare System | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Diagnostic Radiology Physician
- Stateline, NV
- NPI 1467046102
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1130976000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1195171200000",
"number": "1750372116",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 529",
"city": "ZEPHYR COVE",
"state": "NV",
"postal_code": "894480529",
"telephone_number": "775-588-8938",
"fax_number": "775-588-8930"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1139 3RD ST",
"city": "SOUTH LAKE TAHOE",
"state": "CA",
"postal_code": "961503465",
"telephone_number": "530-541-3100",
"fax_number": "530-541-3016"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PROCTOR",
"first_name": "CHRISTOPHER",
"middle_name": "S",
"credential": "PT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-11-03",
"last_updated": "2007-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "CA",
"license": "PT22738",
"primary": true
},
{
"code": "225100000X",
"taxonomy_group": "",
"desc": "Physical Therapist",
"state": "NV",
"license": "1203",
"primary": false
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "P00211696",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "CC7486",
"state": "NV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDI-CAL",
"identifier": "PT0227380",
"state": "CA"
}
],
"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 Nov 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.