Unknown Individual – Emergency Medicine Physician, NPI 1013914902

Unknown Individual is a healthcare provider. based in South lake tahoe, California. specializing in Emergency Medicine Physician. They hold a License No. G57646 (CA). The NPI Number for Unknown Individual is 1013914902

Main info

Organization
Inactive
Name
Unknown Individual
NPI
1013914902
Phone
(530) 543-5659
Address
1111 EMERALD BAY RD
Deactivation Date
27 March 2025
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience14
Completeness75
Years active:0State licenses:1Digital endpointsOther names

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Provider Addresses for Unknown Individual

  • 1111, Emerald Bay Road, Tahoe Valley, South Lake Tahoe, California, 96150, United States

    SOUTH LAKE TAHOE, CA 961506207

    Phone: (530) 543-5659

    Fax: (530) 541-8723

    Type: Mailing

  • South Lake Tahoe, California, United States

    SOUTH LAKE TAHOE, CA 961507026

    Phone: (530) 541-3420

    Type: Location

  • 1501-A Kirkwood Meadows Dr

    Kirkwood, CA 95646

    Phone: (209) 258-7236

    Type: Location

  • 3860 Saddle Rd

    South Lake Tahoe, CA 961508673

    Phone: (530) 543-5575

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

No Medicare enrollment or revalidation data available for this provider in our database.

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 96150)

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Reviews

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Frequently asked questions

What number should I use to identify Unknown Individual for billing?
Administrative and clinical systems typically use NPI 1013914902 for Unknown Individual.
What should I verify if Unknown Individual is listed inactive?
If Unknown Individual looks inactive here, cross-check state licensing and the clinic website.
How should patients interpret Unknown Individual's specialty?
The extract shows Emergency Medicine Physician for Unknown Individual. Clinical services aligned with this taxonomy classification.
Which community is linked to Unknown Individual?
Unknown Individual shows a connection to South Lake Tahoe, California in registry-derived data.
What is the difference between NPI and a medical license?
An NPI is a federal identifier; a medical license is issued by a state and governs where someone may practice.

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