Active NPI
Jason Michael Graham, ATC, LAT
- Athletic Trainer
- Clive, IA
National Provider Identifier
1023316932
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 24-00667
- Practice address
- 12499 University Ave Ste 210
Clive, IA 50325-8288 - Phone
- (515) 240-2676
- NPI assigned
- Mar 2, 2011
- 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 | 24-00667 | KS | Primary |
Addresses
Primary practice location
12499 University Ave Ste 210
Clive, IA 50325-8288
Mailing address
5724 Clark Blvd
Des Moines, IA 50311-2052
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 |
|---|---|---|---|
| 24-00667 | KS | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1299024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1622592000000",
"number": "1023316932",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5724 CLARK BLVD",
"city": "DES MOINES",
"state": "IA",
"postal_code": "503112052"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12499 UNIVERSITY AVE STE 210",
"city": "CLIVE",
"state": "IA",
"postal_code": "503258288",
"telephone_number": "515-240-2676"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRAHAM",
"first_name": "JASON",
"middle_name": "MICHAEL",
"name_prefix": "Mr.",
"credential": "ATC, LAT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-03-02",
"last_updated": "2021-06-02",
"certification_date": "2021-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "KS",
"license": "24-00667",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clive, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.