Active NPI
Jeremy R. Gall, ATC
- Athletic Trainer
- Fort Wayne, IN
National Provider Identifier
1063409332
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 36001023A
- Practice address
- 3701 Carroll Rd
Fort Wayne, IN 46818-9528 - Phone
- (260) 637-3161
- NPI assigned
- Oct 3, 2005
- 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 |
|---|---|---|---|---|
| Sports Medicine (Physical Medicine & Rehabilitation) Physician | 2081S0010X | 36001023A | IN | |
| Athletic Trainer | 2255A2300X | 36001023A | IN | Primary |
Addresses
Primary practice location
3701 Carroll Rd
Fort Wayne, IN 46818-9528
Mailing address
229 Barouche PL
Fort Wayne, IN 46845-2110
Phone (260) 740-1261
Other practice location 1
10106 DuPont Circle Dr E
Fort Wayne, IN 46825-1639
Phone (260) 479-2744
Other practice location 2
7601 W Jefferson Blvd
Fort Wayne, IN 46804-4133
Phone (260) 435-2620
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 36001023A | Other | IN | INDIANA ATHLETIC TRAINERS LICENSE |
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 |
|---|---|---|---|
| 36001023A | IN | MD | Sports Medicine (Physical Medicine & Rehabilitation) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1128297600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1778630400000",
"number": "1063409332",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "229 BAROUCHE PL",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468452110",
"telephone_number": "260-740-1261"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3701 CARROLL RD",
"city": "FORT WAYNE",
"state": "IN",
"postal_code": "468189528",
"telephone_number": "260-637-3161"
}
],
"practiceLocations": [
{
"address_1": "10106 DuPont Circle Dr E",
"address_purpose": "LOCATION",
"city": "Fort Wayne",
"state": "IN",
"postal_code": "468251639",
"country_code": "US",
"telephone_number": "260-479-2744",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "7601 W Jefferson Blvd",
"address_purpose": "LOCATION",
"city": "Fort Wayne",
"state": "IN",
"postal_code": "468044133",
"country_code": "US",
"telephone_number": "260-435-2620",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "GALL",
"first_name": "JEREMY",
"middle_name": "R.",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-10-03",
"last_updated": "2026-05-13",
"certification_date": "2026-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "2081S0010X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation, Sports Medicine",
"state": "IN",
"license": "36001023A",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IN",
"license": "36001023A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "INDIANA ATHLETIC TRAINERS LICENSE",
"identifier": "36001023A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fort Wayne, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.