Active NPI
Shane T Phillips, MED, ATC/L, PES
- Athletic Trainer
- Anchorage, AK
National Provider Identifier
1063283463
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 123978
- Practice address
- 5955 Zeamer Ave
Anchorage, AK 99506-3702 - Phone
- (907) 580-2778
- NPI assigned
- Jan 15, 2024
- 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 | 123978 | IA | Primary |
Addresses
Primary practice location
5955 Zeamer Ave
Anchorage, AK 99506-3702
Mailing address
4610 Reka Dr Apt A19
Anchorage, AK 99508-3614
Phone (303) 883-6151
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
- Credentials
- Master of Education
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 123978 | IA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1705276800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1705276800000",
"number": "1063283463",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4610 REKA DR APT A19",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995083614",
"telephone_number": "303-883-6151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5955 ZEAMER AVE",
"city": "ANCHORAGE",
"state": "AK",
"postal_code": "995063702",
"telephone_number": "907-580-2778"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPS",
"first_name": "SHANE",
"middle_name": "T",
"credential": "MED, ATC/L, PES",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-01-15",
"last_updated": "2024-01-15",
"certification_date": "2024-01-12",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IA",
"license": "123978",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Anchorage, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.