Individual provider Active NPI

Jean Peters Makris, MD

  • Hospitalist Physician
  • South Lake Tahoe, CA
National Provider Identifier
1952308710
Registry record updated Nov 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hospitalist PhysicianTaxonomy code 208M00000X
License
A77127 Issued in CA
Practice address
2170 South Ave
South Lake Tahoe, CA 96150-7026
Phone
(530) 541-3420
Fax
(530) 541-8723
NPI assigned
Jul 7, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 6, 2017

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X A77127 CA
Hospitalist Physician 208M00000X A77127 CA Primary

Addresses

Primary practice location

2170 South Ave
South Lake Tahoe, CA 96150-7026

Mailing address

1111 Emerald Bay Rd
South Lake Tahoe, CA 96150-6207
Phone (530) 543-5659

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20031204001260 CA Practitioner - Family Practice 2860397551 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Barton Healthcare System Family Medicine CurrentSince Sep 22, 2014 Accepting new patients

Locations

2201 South Ave
South Lake Tahoe, CA 96150
Phone (530) 543-5550

1111 Emerald Bay Rd
South Lake Tahoe, CA 96150
Phone (530) 543-5659

2170 South Ave
South Lake Tahoe, CA 96150
Phone (530) 541-3420

Interoperability endpoints

  • Direct secure messaging: jmakris65089@direct.renown.org

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1509926400000",
    "number": "1952308710",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1111 EMERALD BAY RD",
            "city": "SOUTH LAKE TAHOE",
            "state": "CA",
            "postal_code": "961506207",
            "telephone_number": "530-543-5659",
            "fax_number": "530-541-8723"
        },
        {
            "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": "530-541-3420",
            "fax_number": "530-541-8723"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAKRIS",
        "first_name": "JEAN",
        "middle_name": "PETERS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-07",
        "last_updated": "2017-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A77127",
            "primary": false
        },
        {
            "code": "208M00000X",
            "taxonomy_group": "",
            "desc": "Hospitalist",
            "state": "CA",
            "license": "A77127",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Lake Tahoe, CA

Sources for this page

Verify at the official NPI Registry.