MEDICARE: EASTERN SIERRA MEDICAL GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician
2	363A00000X	Physician Assistant
3	261QR1300X	Rural Health Clinic/Center	7714RHC-0	NV

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CJ7646	OTHER	NV	RR MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316925381
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EASTERN SIERRA MEDICAL GROUP LLC

Provider Business Mailing Address
First Line	:	1155 MILL ST # M14
Second Line	:
City	:	RENO
State	:	NV
Zip	:	89502-1576
Country	:	US
Telephone Number	:	775-982-5262
Fax Number	:	775-982-5496

Provider Business Practice Location Address
First Line	:	3595 US HIGHWAY 50
Second Line	:
City	:	SILVER SPRINGS
State	:	NV
Zip	:	89429-9613
Country	:	US
Telephone Number	:	775-982-5000
Fax Number	:	775-982-3900

Authorized Official
Title or Position	:	CFO ACUTE CARE
Name	:	BRETT MOORE
Credential	:
Telephone Number	:	775-982-6343

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	07/30/2025

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Directions to “EASTERN SIERRA MEDICAL GROUP LLC ” Practice Location

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