Active NPI
Jason Phillip Nussbaum, MS, ATC
- Athletic Trainer
- Blythewood, SC
National Provider Identifier
1013157452
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 858
- Practice address
- 180 Turkey Farm Rd
Blythewood, SC 29016-9699 - Phone
- (803) 381-0168
- NPI assigned
- Feb 25, 2009
- Last updated
- Dec 23, 2014
- Sex
- Male
- Sole proprietor
- No
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 | 858 | SC | Primary |
Addresses
Primary practice location
180 Turkey Farm Rd
Blythewood, SC 29016-9699
Mailing address
180 Turkey Farm Rd
Blythewood, SC 29016-9699
Phone (803) 381-0168
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 |
|---|---|---|---|
| 858 | SC | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1235520000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1419292800000",
"number": "1013157452",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "180 TURKEY FARM RD",
"city": "BLYTHEWOOD",
"state": "SC",
"postal_code": "290169699",
"telephone_number": "803-381-0168"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "180 TURKEY FARM RD",
"city": "BLYTHEWOOD",
"state": "SC",
"postal_code": "290169699",
"telephone_number": "803-381-0168"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NUSSBAUM",
"first_name": "JASON",
"middle_name": "PHILLIP",
"name_prefix": "Mr.",
"credential": "MS, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2009-02-25",
"last_updated": "2014-12-23",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "SC",
"license": "858",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Blythewood, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.