Active NPI
Brad Michael Crackel, LAT, ATC, OTC
- Athletic Trainer
- Avon, IN
National Provider Identifier
1104884832
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 36000849A
- Practice address
- 8607 E US Highway 36
Avon, IN 46123-7960 - Phone
- (317) 208-3866
- NPI assigned
- May 2, 2006
- 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 | 36000849A | IN | Primary |
Addresses
Primary practice location
8607 E US Highway 36
Avon, IN 46123-7960
Mailing address
8167 Crumwell Dr
Avon, IN 46123-7007
Phone (317) 438-6248
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 |
|---|---|---|---|
| 36000849A | IN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146528000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1448236800000",
"number": "1104884832",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8167 CRUMWELL DR",
"city": "AVON",
"state": "IN",
"postal_code": "461237007",
"telephone_number": "317-438-6248"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8607 E US HIGHWAY 36",
"city": "AVON",
"state": "IN",
"postal_code": "461237960",
"telephone_number": "317-208-3866"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CRACKEL",
"first_name": "BRAD",
"middle_name": "MICHAEL",
"credential": "LAT, ATC, OTC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-05-02",
"last_updated": "2015-11-23",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IN",
"license": "36000849A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Avon, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.