Active NPI
Derek Lutz, ATC
- Athletic Trainer
- Columbus, OH
National Provider Identifier
1053922211
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT03402
- Practice address
- 834 Thurber Dr W Apt 25
Columbus, OH 43215-1278 - Phone
- (740) 415-6316
- NPI assigned
- Aug 12, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Athletic Trainer | 2255A2300X | AT03402 | SC | Primary |
Addresses
Primary practice location
834 Thurber Dr W Apt 25
Columbus, OH 43215-1278
Mailing address
351 Mill Rd SW
Lancaster, OH 43130-9039
Phone (740) 415-6316
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 |
|---|---|---|---|
| AT03402 | SC | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1597190400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1696464000000",
"number": "1053922211",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "351 MILL RD SW",
"city": "LANCASTER",
"state": "OH",
"postal_code": "431309039",
"telephone_number": "740-415-6316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "834 THURBER DR W APT 25",
"city": "COLUMBUS",
"state": "OH",
"postal_code": "432151278",
"telephone_number": "740-415-6316"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUTZ",
"first_name": "DEREK",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-08-12",
"last_updated": "2023-10-05",
"certification_date": "2023-10-05",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "SC",
"license": "AT03402",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Columbus, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.