Active NPI
Braeden James Rideoutt, ATC
- Athletic Trainer
- Allen Park, MI
National Provider Identifier
1083403802
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 222 Republic Dr
Allen Park, MI 48101-3650 - Phone
- (970) 999-2775
- NPI assigned
- May 6, 2025
- 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 | Primary |
Addresses
Primary practice location
222 Republic Dr
Allen Park, MI 48101-3650
Mailing address
222 Republic Dr
Allen Park, MI 48101-3650
Phone (970) 999-2775
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1746489600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1782000000000",
"number": "1083403802",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "222 REPUBLIC DR",
"city": "ALLEN PARK",
"state": "MI",
"postal_code": "481013650",
"telephone_number": "970-999-2775",
"fax_number": "970-999-2775"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "222 REPUBLIC DR",
"city": "ALLEN PARK",
"state": "MI",
"postal_code": "481013650",
"telephone_number": "970-999-2775"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RIDEOUTT",
"first_name": "BRAEDEN",
"middle_name": "JAMES",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2025-05-06",
"last_updated": "2026-06-21",
"certification_date": "2026-06-21",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Allen Park, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 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.