Lydia B O'Bannon, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

Practice address

2170 South Ave
South Lake Tahoe, CA 96150-7026

Phone

(530) 543-5554

Fax

(530) 541-3016

NPI assigned

Oct 30, 2013

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other names 1

• Lydia E Barrett Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

Practice roles

Locations

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

• Doctors Making Housecalls Internal Medicine,PA

  • Internal Medicine Physician
  • Durham, NC
  • NPI 1083854897
  NPD

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

{
    "created_epoch": "1383091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1561420800000",
    "number": "1770911620",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3001 EDWARDS MILL RD",
            "address_2": "#200",
            "city": "RALEIGH",
            "state": "NC",
            "postal_code": "276125243",
            "telephone_number": "919-781-5600",
            "fax_number": "919-863-6821"
        },
        {
            "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": "530-543-5554",
            "fax_number": "530-541-3016"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "212 Elks Point Rd Ste 200",
            "address_purpose": "LOCATION",
            "city": "Zephyr Cove",
            "state": "NV",
            "postal_code": "894488001",
            "country_code": "US",
            "telephone_number": "775-589-8950",
            "fax_number": "775-588-1299",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "935 Mica Dr Ste 13",
            "address_purpose": "LOCATION",
            "city": "Carson City",
            "state": "NV",
            "postal_code": "897057181",
            "country_code": "US",
            "telephone_number": "775-783-3065",
            "fax_number": "775-267-1829",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "O'BANNON",
        "first_name": "LYDIA",
        "middle_name": "B",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-10-30",
        "last_updated": "2019-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LYDIA",
            "last_name": "BARRETT",
            "middle_name": "E",
            "credential": "PA-C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Peter Nocka
• Meagan Nordstrom, MD
• Daniel Arthur Norman, MD
• Jenifer Elyce Norris, MD
• Lynn Dorothy Norton, RD
• Targhee Orr Oeveraas, MD
• Judith Gretchen Ogden, LMFT
• Diane G Oliver, MD
• Aimee Orozco
• Alejandra Orozco

• Physician Assistant in South Lake Tahoe, CA
• Providers in South Lake Tahoe, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.