Jeremy Scott Vandehurst, L-AT

Primary specialty

Sports Medicine (Emergency Medicine) PhysicianTaxonomy code 207PS0010X

License

0506428 Issued in NV

Practice address

2170 South Ave # B
South Lake Tahoe, CA 96150-7008

Phone

(530) 208-8253

NPI assigned

Mar 11, 2020

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 6

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1583884800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1583884800000",
    "number": "1861027625",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2795 SPRINGWOOD DR",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961502815",
            "telephone_number": "530-208-8253"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2170 SOUTH AVE # B",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961507008",
            "telephone_number": "530-208-8253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VANDEHURST",
        "first_name": "JEREMY",
        "middle_name": "SCOTT",
        "name_prefix": "Mr.",
        "credential": "L-AT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-11",
        "last_updated": "2020-03-11",
        "certification_date": "2020-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174H00000X",
            "taxonomy_group": "",
            "desc": "Health Educator",
            "state": "NV",
            "license": "0506428",
            "primary": false
        },
        {
            "code": "207XX0005X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery, Sports Medicine",
            "state": "NV",
            "license": "0506428",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "NV",
            "license": "0506428",
            "primary": false
        },
        {
            "code": "226300000X",
            "taxonomy_group": "",
            "desc": "Kinesiotherapist",
            "state": "NV",
            "license": "0506428",
            "primary": false
        },
        {
            "code": "405300000X",
            "taxonomy_group": "",
            "desc": "Prevention Professional",
            "state": "NV",
            "license": "0506428",
            "primary": false
        },
        {
            "code": "207PS0010X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": "NV",
            "license": "0506428",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ksenia Ustinova, LCSW
• April France Vadnais
• Lucila Valencia-Salazar
• Leeann Rose Vanbeenen
• Deborah Ann Vance, MFCC
• Nicole Marie Vandehurst, MA
• Michel George Vangordon, MA, LMFT
• Kimberly Angela Vankirk, LCSW
• Kelly Vial, FNP
• Victoria Viccaro

• All providers in South Lake Tahoe, CA
• Sports Medicine (Emergency Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 11, 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.