Active NPI
Jennifer E Meyer, DAT, LAT, ATC
- Athletic Trainer
- University Park, IL
National Provider Identifier
1104309624
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096.004578
- Practice address
- 1 University Pkwy
University Park, IL 60484-3165 - Phone
- (708) 235-2187
- NPI assigned
- Sep 11, 2018
- Sex
- Female
- Sole proprietor
- Yes
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 | 096.004578 | IL | Primary |
Addresses
Primary practice location
1 University Pkwy
University Park, IL 60484-3165
Mailing address
17110 S Heritage Dr
Homer Glen, IL 60491-8244
Phone (815) 263-6488
Other practice location 1
15960 Ashford Ct
Tinley Park, IL 60477-6750
Phone (815) 263-6488
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 096.004578 | Other | IL | DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION OF IL |
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 |
|---|---|---|---|
| 096.004578 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536624000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1645747200000",
"number": "1104309624",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17110 S HERITAGE DR",
"city": "HOMER GLEN",
"state": "IL",
"postal_code": "604918244",
"telephone_number": "815-263-6488"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 UNIVERSITY PKWY",
"city": "UNIVERSITY PARK",
"state": "IL",
"postal_code": "604843165",
"telephone_number": "708-235-2187"
}
],
"practiceLocations": [
{
"address_1": "15960 Ashford Ct",
"address_purpose": "LOCATION",
"city": "Tinley Park",
"state": "IL",
"postal_code": "604776750",
"country_code": "US",
"telephone_number": "815-263-6488",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MEYER",
"first_name": "JENNIFER",
"middle_name": "E",
"name_prefix": "Dr.",
"credential": "DAT, LAT, ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-09-11",
"last_updated": "2022-02-25",
"certification_date": "2022-02-25",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096.004578",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPARTMENT OF FINANCIAL AND PROFESSIONAL REGULATION OF IL",
"identifier": "096.004578",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in University Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.