Tahoe Orthopedics and Sports Medicine – Orthopaedic Surgery Physician, NPI 1609937911
Orthopaedic Surgery Physician
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for Tahoe Orthopedics and Sports Medicine
935 Mica Dr Ste 13
Carson City, NV 897057181
Phone: (775) 783-3065
Fax: (775) 267-1829
Type: Location
925 Tahoe Blvd Ste 105
Incline Village, NV 894517498
Phone: (775) 580-7600
Fax: (775) 831-0946
Type: Location
2170 SOUTH AVE
SOUTH LAKE TAHOE, CA 961507026
Phone: (530) 543-5659
Fax: (530) 541-8723
Type: Mailing
212 ELKS POINT RD STE 200
ZEPHYR COVE, NV 894488001
Phone: (775) 589-8950
Fax: (775) 588-1299
Type: Location
1111, Emerald Bay Road, Tahoe Valley, South Lake Tahoe, El Dorado County, California, 96150, United States
SOUTH LAKE TAHOE, CA 961506207
Phone: (530) 543-5659
Fax: (530) 541-8723
Type: Mailing
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.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2003-12-03
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Past revalidation due date
Earliest CMS due date was 2024-01-31 (861 days ago).
Enrollment records
1
Earliest due date
2024-01-31
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| O20031203000511 | O | Clinic/Group Practice | NV | 2024-01-31 |
What to do next
- Verify current status on the CMS Revalidation Lookup Tool immediately.
- Complete revalidation in PECOS or contact your Medicare Administrative Contractor (MAC).
- Overdue revalidation can lead to deactivation of Medicare billing privileges.
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 89705)
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