Active NPI
Lucas Polley
- Athletic Trainer
- Centerville, OH
National Provider Identifier
1023467917
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 004411
- Practice address
- 2400 Miami Valley Dr
Sports Medicine Ceter
Centerville, OH 45459-4774 - Phone
- (937) 876-9833
- NPI assigned
- Jun 10, 2016
- 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 | 004411 | OH | Primary |
Addresses
Primary practice location
2400 Miami Valley Dr
Sports Medicine Ceter
Centerville, OH 45459-4774
Mailing address
134 Maynard Dr
Apt. a
Tipp City, OH 45371-1579
Phone (937) 876-9833
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 |
|---|---|---|---|
| 004411 | OH | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1465516800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1465516800000",
"number": "1023467917",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "134 MAYNARD DR",
"address_2": "APT. A",
"city": "TIPP CITY",
"state": "OH",
"postal_code": "453711579",
"telephone_number": "937-876-9833"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2400 MIAMI VALLEY DR",
"address_2": "SPORTS MEDICINE CETER",
"city": "CENTERVILLE",
"state": "OH",
"postal_code": "454594774",
"telephone_number": "937-876-9833"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POLLEY",
"first_name": "LUCAS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2016-06-10",
"last_updated": "2016-06-10",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OH",
"license": "004411",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Centerville, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 10, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.