Douglas Paul Ganassi, MED - EX. SCI., ATC,

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

RT002222A Issued in PA

Practice address

1750 Clairton Road, Route 885
Ccac - South Campus
West Mifflin, PA 15122-3097

Phone

(412) 469-1100

Fax

(412) 469-6254

NPI assigned

Jun 11, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1339372800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1385942400000",
    "number": "1104188614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 ALLEGHENY AVENUE",
            "address_2": "CCAC",
            "city": "PITTSBURGH",
            "state": "PA",
            "postal_code": "152331895",
            "telephone_number": "412-237-3121",
            "fax_number": "412-237-3135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 CLAIRTON ROAD, ROUTE 885",
            "address_2": "CCAC - SOUTH CAMPUS",
            "city": "WEST MIFFLIN",
            "state": "PA",
            "postal_code": "151223097",
            "telephone_number": "412-469-1100",
            "fax_number": "412-469-6254"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GANASSI",
        "first_name": "DOUGLAS",
        "middle_name": "PAUL",
        "name_prefix": "Mr.",
        "credential": "MED - EX. SCI., ATC,",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-06-11",
        "last_updated": "2013-12-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "PA",
            "license": "RT002222A",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "GA",
            "license": "AT000369",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in West Mifflin, PA
• Providers in West Mifflin, PA by specialty
• Athletic Trainer in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 2, 2013; 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.