Active NPI
Matthew Thomas Oliphant
- Athletic Trainer
- Fargo, ND
National Provider Identifier
1053873802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 940-22
- Practice address
- 1720 South University Hospital
Fargo, ND 58103 - Phone
- (701) 417-6000
- NPI assigned
- Apr 2, 2019
- Reactivated
- Jul 23, 2020
- 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 | 940-22 | ND | Primary |
Addresses
Primary practice location
1720 South University Hospital
Fargo, ND 58103
Mailing address
3223 32ND Ave S
Fargo, ND 58103-6297
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 |
|---|---|---|---|
| 940-22 | ND | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1758585600000",
"number": "1053873802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3223 32ND AVE S",
"city": "FARGO",
"state": "ND",
"postal_code": "581036297"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1720 SOUTH UNIVERSITY HOSPITAL",
"city": "FARGO",
"state": "ND",
"postal_code": "58103",
"telephone_number": "701-417-6000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLIPHANT",
"first_name": "MATTHEW",
"middle_name": "THOMAS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-04-02",
"last_updated": "2025-09-23",
"certification_date": "2025-09-23",
"deactivation_date": "2020-02-25",
"reactivation_date": "2020-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "ND",
"license": "940-22",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.