Active NPI
Timothy Ellis, ATC
- Athletic Trainer
- Wayne, NE
National Provider Identifier
1114388303
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 54
- Practice address
- 1200 Providence Rd
Wayne, NE 68787-1212 - Phone
- (402) 375-7937
- Fax
- (402) 375-7956
- NPI assigned
- Mar 15, 2016
- Sex
- Male
- 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 | 54 | NE | Primary |
Addresses
Primary practice location
1200 Providence Rd
Wayne, NE 68787-1212
Mailing address
1200 Providence Rd
Wayne, NE 68787-1212
Phone (402) 375-7937
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 |
|---|---|---|---|
| 54 | NE | MD | Pediatric Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1458000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458000000000",
"number": "1114388303",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 PROVIDENCE RD",
"city": "WAYNE",
"state": "NE",
"postal_code": "687871212",
"telephone_number": "402-375-7937",
"fax_number": "402-375-7956"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 PROVIDENCE RD",
"city": "WAYNE",
"state": "NE",
"postal_code": "687871212",
"telephone_number": "402-375-7937",
"fax_number": "402-375-7956"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "TIMOTHY",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-03-15",
"last_updated": "2016-03-15",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NE",
"license": "54",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wayne, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.