Individual provider Active NPI

Jean Ann Bagel, ATC

  • Athletic Trainer
  • Arlington Heights, IL
National Provider Identifier
1073629341
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
Practice address
2121 S Goebbert Rd
Arlington Heights, IL 60005-4205
Phone
(847) 718-4176
NPI assigned
Aug 21, 2006
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X IL Primary

Addresses

Primary practice location

2121 S Goebbert Rd
Arlington Heights, IL 60005-4205

Mailing address

15 S Prindle Ave
Arlington Heights, IL 60004-6537
Phone (847) 749-1932

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

LicenseStateTypeSpecialty
096000114ILMDAthletic Trainer

NPI Registry JSON

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

{
    "created_epoch": "1156118400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1073629341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 S PRINDLE AVE",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600046537",
            "telephone_number": "847-749-1932"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 S GOEBBERT RD",
            "city": "ARLINGTON HEIGHTS",
            "state": "IL",
            "postal_code": "600054205",
            "telephone_number": "847-718-4176"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAGEL",
        "first_name": "JEAN",
        "middle_name": "ANN",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-08-21",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Arlington Heights, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.