Active NPI
Mitch Taffe, M.S., ATC, CSCS
- Athletic Trainer
- Bloomington, IN
National Provider Identifier
1003354242
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 36002707A
- Practice address
- 1001 E 17TH St
Athletic Training
Bloomington, IN 47408-1590 - Phone
- (320) 305-1147
- NPI assigned
- Feb 8, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 36002707A | IN | Primary |
Addresses
Primary practice location
1001 E 17TH St
Athletic Training
Bloomington, IN 47408-1590
Mailing address
1212 N Grant St Apt 6B
Bloomington, IN 47408-1824
Phone (320) 305-1147
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| YRP053M85918 | Other | IN | BLUECROSS BLUESHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36002707A | IN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1486512000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1486512000000",
"number": "1003354242",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1212 N GRANT ST APT 6B",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474081824",
"telephone_number": "320-305-1147"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1001 E 17TH ST",
"address_2": "ATHLETIC TRAINING",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474081590",
"telephone_number": "320-305-1147"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TAFFE",
"first_name": "MITCH",
"credential": "M.S., ATC, CSCS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-02-08",
"last_updated": "2017-02-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IN",
"license": "36002707A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUECROSS BLUESHIELD",
"identifier": "YRP053M85918",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 8, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.