Active NPI
Lewis Tarr Jr.
- Licensed Vocational Nurse
- Grass Valley, CA
National Provider Identifier
1790281749
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Vocational Nurse
- License
- VN158152
- Practice address
- 145 Glasson Way
Grass Valley, CA 95945-5723 - Phone
- (530) 470-2425
- NPI assigned
- Mar 30, 2018
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Vocational Nurse | 164X00000X | VN158152 | CA | Primary |
Addresses
Primary practice location
145 Glasson Way
Grass Valley, CA 95945-5723
Mailing address
145 Glasson Way
Grass Valley, CA 95945-5723
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 93463515C87079 | Medicaid | CA |
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)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| VN158152 | CA | MD | Licensed Vocational Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522368000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522368000000",
"number": "1790281749",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "145 GLASSON WAY",
"city": "GRASS VALLEY",
"state": "CA",
"postal_code": "959455723"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "145 GLASSON WAY",
"city": "GRASS VALLEY",
"state": "CA",
"postal_code": "959455723",
"telephone_number": "530-470-2425"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TARR",
"first_name": "LEWIS",
"name_suffix": "Jr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-03-30",
"last_updated": "2018-03-30",
"status": "A"
},
"taxonomies": [
{
"code": "164X00000X",
"taxonomy_group": "",
"desc": "Licensed Vocational Nurse",
"state": "CA",
"license": "VN158152",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "93463515C87079",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Grass Valley, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.