Active NPI
Dillon John Fasse, LAT, ATC
- Athletic Trainer
- Menomonee Falls, WI
National Provider Identifier
1003357005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1929-39
- Practice address
- W156N9000 Pilgrim Rd
Menomonee Falls, WI 53051-2272 - Phone
- (262) 502-8752
- NPI assigned
- Mar 10, 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 | 1929-39 | WI | Primary |
Addresses
Primary practice location
W156N9000 Pilgrim Rd
Menomonee Falls, WI 53051-2272
Mailing address
W290S4827 Parke LN W
Waukesha, WI 53189-9047
Phone (262) 391-7952
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1929-39 | WI | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Premise Health of Connecticut Medical, P.C. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Occupational Medicine Clinic/Center
- Menomonee Falls, WI
- NPI 1770868135
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1489104000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1489104000000",
"number": "1003357005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "W290S4827 PARKE LN W",
"city": "WAUKESHA",
"state": "WI",
"postal_code": "531899047",
"telephone_number": "262-391-7952"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "W156N9000 PILGRIM RD",
"city": "MENOMONEE FALLS",
"state": "WI",
"postal_code": "530512272",
"telephone_number": "262-502-8752"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FASSE",
"first_name": "DILLON",
"middle_name": "JOHN",
"name_prefix": "Mr.",
"credential": "LAT, ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-03-10",
"last_updated": "2017-03-10",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "1929-39",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Menomonee Falls, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 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.