Mountain Meadows Medical Group of California, Inc.

Primary specialty

Obstetrics & Gynecology PhysicianTaxonomy code 207V00000X

License

207V00000X Issued in CA

Legal business name

MOUNTAIN MEADOWS MEDICAL GROUP OF CALIFORNIA, INC.

Doing business as

Tahoe Women's Care

Practice address

1067 4TH St
S Lake Tahoe, CA 96150-3459

Phone

(530) 543-5710

Fax

(530) 542-1455

NPI assigned

Feb 28, 2007

Last updated

Sep 19, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kris F Kobalter, MDNPI 1255302972

Title

Vice President

Phone

(530) 543-5710

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Tahoe Women's Care Doing business as

Medicare fee-for-service enrollment

Enrolled in CA

Enrollment records 1

Other NPIs with the same Medicare PAC ID 1

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

• Mountain Meadows Medical Group of California, Inc.

  dba Tahoe Women's Care

  • Obstetrics & Gynecology Physician
  • Carson City, NV
  • NPI 1497936694

  5597750349

  Same PAC ID

Tax ID family

Mountain Meadows Med GRP2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Mountain Meadows Medical Group of California, Inc.

  dba Tahoe Women's Care

  • Obstetrics & Gynecology Physician
  • Carson City, NV
  • NPI 1497936694
  NPD tax ID

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Gary F Willen, MD

  • Obstetrics & Gynecology Physician
  • Carson City, NV
  • NPI 1700857422

  CA

  Medicare reassignment NPD
• Kris Francis Kobalter, MD

  • Obstetrics & Gynecology Physician
  • Richland, WA
  • NPI 1255302972
  NPD (past) Authorized official
• Caroline G Habaradas, MD

  • Obstetrics & Gynecology Physician
  • Carson City, NV
  • NPI 1073584785
  NPD (past)

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

{
    "created_epoch": "1172620800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1348012800000",
    "number": "1972630432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1067 4TH ST",
            "city": "S LAKE TAHOE",
            "state": "CA",
            "postal_code": "961503459",
            "telephone_number": "530-543-5710",
            "fax_number": "530-542-1455"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1067 4TH ST",
            "city": "S LAKE TAHOE",
            "state": "CA",
            "postal_code": "961503459",
            "telephone_number": "530-543-5710",
            "fax_number": "530-542-1455"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNTAIN MEADOWS MEDICAL GROUP OF CALIFORNIA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-02-28",
        "last_updated": "2012-09-19",
        "status": "A",
        "authorized_official_last_name": "KOBALTER",
        "authorized_official_first_name": "KRIS",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "VICE PRESIDENT",
        "authorized_official_telephone_number": "530-543-5710",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207V00000X",
            "taxonomy_group": "",
            "desc": "Obstetrics & Gynecology",
            "state": "CA",
            "license": "207V00000X",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GR0023700",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tahoe Women's Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jessica H Jones, PT
• Jay Kaplan, DDS
• Esther Ludia Kulecho-King
• Youngsyl Oh Lee, D.D.S.
• Mark Matthew Lehmann, OD
• Patricia Jane Murphy, RN PHN
• R Scott Nanamura, LAC
• Maria D Quirarte
• R Scott Nanamura Ac Inc
• Richard N Alexander (Emerald Bay Physical Therapy)

• Obstetrics & Gynecology Physician in S Lake Tahoe, CA
• Providers in S Lake Tahoe, CA by specialty
• Obstetrics & Gynecology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.