{"npi":"1508865528","type":"NPI-2","status":"active","name":{"display":"Tahoe Carson Valley Medical Group INC","other":[],"organization_name":"TAHOE CARSON VALLEY MEDICAL GROUP INC","authorised_official":"David Young"},"specialty":{"primary_taxonomy":"207Q00000X","primary_taxonomy_description":"Family Medicine","slug":"family-medicine","schema_org_specialty":"PrimaryCare","all":[{"code":"207P00000X","description":"Emergency Medicine","primary":false,"state":null,"license":null},{"code":"207R00000X","description":"Internal Medicine","primary":false,"state":null,"license":null},{"code":"207RC0000X","description":"Cardiovascular Disease","primary":false,"state":null,"license":null},{"code":"207RR0500X","description":"Rheumatology Physician","primary":false,"state":null,"license":null},{"code":"207V00000X","description":"Obstetrics & Gynecology","primary":false,"state":null,"license":null},{"code":"207Y00000X","description":"Otolaryngology Physician","primary":false,"state":null,"license":null},{"code":"208000000X","description":"Pediatrics","primary":false,"state":null,"license":null},{"code":"2084P0800X","description":"Psychiatry","primary":false,"state":null,"license":null},{"code":"208600000X","description":"Surgery","primary":false,"state":null,"license":null},{"code":"208800000X","description":"Urology Physician","primary":false,"state":null,"license":null},{"code":"208M00000X","description":"Hospitalist","primary":false,"state":null,"license":null},{"code":"207Q00000X","description":"Family Medicine","primary":true,"state":null,"license":null}]},"addresses":[{"purpose":"LOCATION","street_1":"2170 SOUTH AVE","city":"SOUTH LAKE TAHOE","state":"CA","postal_code":"96150","country_code":"US","phone":"5305413420","fax":"5305418723"},{"purpose":"MAILING","street_1":"2170 SOUTH AVE","city":"SOUTH LAKE TAHOE","state":"CA","postal_code":"961507026","country_code":"US","phone":"5305435659","fax":"5305418723"}],"license":null,"identifiers":[{"type_code":"01","label":"Other","value":"USA293250","state":"CA","issuer":"BLUE SHIELD OF CA"},{"type_code":"05","label":"Medicaid","value":"XGG007610","state":"CA","issuer":null},{"type_code":"01","label":"Other","value":"ZZZ14014Z","state":"CA","issuer":"BLUE SHIELD OF CA"},{"type_code":"05","label":"Medicaid","value":"GR0055022","state":"CA","issuer":null},{"type_code":"05","label":"Medicaid","value":"GR0055023","state":"CA","issuer":null},{"type_code":"01","label":"Other","value":"USA293170","state":"CA","issuer":"BLUE SHIELD OF CA"},{"type_code":"01","label":"Other","value":"USA292950","state":"CA","issuer":"BLUE SHIELD OF CA"},{"type_code":"01","label":"Other","value":"USA292960","state":"CA","issuer":"BLUE SHIELD OF CA"},{"type_code":"01","label":"Other","value":"USA292970","state":"CA","issuer":"BLUE SHIELD OF CA"},{"type_code":"01","label":"Other","value":"ZZZ61294Z","state":"CA","issuer":"BLUE SHIELD OF CA"},{"type_code":"05","label":"Medicaid","value":"100506149","state":"NV","issuer":null},{"type_code":"05","label":"Medicaid","value":"GR0055020","state":"CA","issuer":null},{"type_code":"01","label":"Other","value":"ZZZ54133Z","state":"CA","issuer":"BLUE SHIELD OF CA"},{"type_code":"05","label":"Medicaid","value":"XGG007612","state":"CA","issuer":null},{"type_code":"01","label":"Other","value":"ZZZ65882Z","state":"CA","issuer":"BLUE SHIELD OF CA"},{"type_code":"05","label":"Medicaid","value":"100506911","state":"CA","issuer":null},{"type_code":"05","label":"Medicaid","value":"GR0055021","state":"CA","issuer":null},{"type_code":"05","label":"Medicaid","value":"XGG007611","state":"CA","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20040514000834","type_code":"12-70","type_desc":"PART B SUPPLIER - CLINIC/GROUP PRACTICE","state":"CA","pac_id":"8426048158"}]},"enumeration_date":"2005-07-20","last_updated":"2023-06-12","_meta":{"source":"NPPES","snapshot_date":"2023-06-12","doc_url":"https://findmynpi.com/api"}}