Active NPI
Michelle Nicole Vande Berg, MS, A.T.,C., CSCS
- Athletic Trainer
- Collegeville, PA
National Provider Identifier
1124159074
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- RT002373A
- Practice address
- 601 East Main St.
Ess Athletics
Collegeville, PA 19426-1000 - Phone
- (610) 409-3000
- Fax
- (610) 409-3776
- NPI assigned
- Mar 9, 2007
- Sex
- Female
- 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 | RT002373A | PA | Primary |
Addresses
Primary practice location
601 East Main St.
Ess Athletics
Collegeville, PA 19426-1000
Mailing address
1111 Cathedral LN
Norristown, PA 19403-5151
Phone (610) 630-1284
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RT002373A | PA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173398400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1124159074",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 CATHEDRAL LN",
"city": "NORRISTOWN",
"state": "PA",
"postal_code": "194035151",
"telephone_number": "610-630-1284"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "601 EAST MAIN ST.",
"address_2": "ESS ATHLETICS",
"city": "COLLEGEVILLE",
"state": "PA",
"postal_code": "194261000",
"telephone_number": "610-409-3000",
"fax_number": "610-409-3776"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANDE BERG",
"first_name": "MICHELLE",
"middle_name": "NICOLE",
"credential": "MS, A.T.,C., CSCS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-03-09",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "PA",
"license": "RT002373A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Collegeville, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.