Jody R Duecker, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

2000007511 Issued in OH

Practice address

19600 N Park Blvd
Shaker Heights, OH 44122-1825

Phone

(216) 320-8796

NPI assigned

Sep 11, 2018

Last updated

Sep 11, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1536624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1536624000000",
    "number": "1033692587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1477 TWINSBURG RD",
            "city": "TWINSBURG",
            "state": "OH",
            "postal_code": "440872395",
            "telephone_number": "330-620-4256"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19600 N PARK BLVD",
            "city": "SHAKER HEIGHTS",
            "state": "OH",
            "postal_code": "441221825",
            "telephone_number": "216-320-8796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DUECKER",
        "first_name": "JODY",
        "middle_name": "R",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-09-11",
        "last_updated": "2018-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "OH",
            "license": "2000007511",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2000007511",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Providers in Shaker Heights, OH by specialty
• Athletic Trainer in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.