Tanner Patrick Krumwiede, MS, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

096004524 Issued in IL

Practice address

800 N State
Jerseyville, IL 62052-6205

Phone

(618) 498-5521

NPI assigned

Apr 25, 2022

Last updated

Apr 25, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1650844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1650844800000",
    "number": "1063156180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 N STATE",
            "city": "JERSEYVILLE",
            "state": "IL",
            "postal_code": "62052",
            "telephone_number": "618-498-5521"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 N STATE",
            "city": "JERSEYVILLE",
            "state": "IL",
            "postal_code": "620526205",
            "telephone_number": "618-498-5521"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRUMWIEDE",
        "first_name": "TANNER",
        "middle_name": "PATRICK",
        "credential": "MS, LAT, ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-04-25",
        "last_updated": "2022-04-25",
        "certification_date": "2022-04-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096004524",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE OF ILLINOIS",
            "identifier": "096004524",
            "state": "IL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NATIONAL BOARD OF CERTIFICATION",
            "identifier": "2000027086",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Jerseyville, IL
• Providers in Jerseyville, IL by specialty
• Athletic Trainer in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2022; 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.