Active NPI
Benjamin Marcus, ATC
- Athletic Trainer
- Fargo, ND
National Provider Identifier
1134624570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 773-17
- Practice address
- 3000 32ND Ave S
Fargo, ND 58103-6132 - Phone
- (701) 231-8011
- NPI assigned
- Mar 28, 2018
- Last updated
- Mar 28, 2018
- 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 | 773-17 | ND | Primary |
Addresses
Primary practice location
3000 32ND Ave S
Fargo, ND 58103-6132
Mailing address
1621 34TH St S Apt 18
Fargo, ND 58103-8416
Phone (845) 705-7864
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 |
|---|---|---|---|
| 773-17 | ND | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522195200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522195200000",
"number": "1134624570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1621 34TH ST S APT 18",
"city": "FARGO",
"state": "ND",
"postal_code": "581038416",
"telephone_number": "845-705-7864"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3000 32ND AVE S",
"city": "FARGO",
"state": "ND",
"postal_code": "581036132",
"telephone_number": "701-231-8011"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MARCUS",
"first_name": "BENJAMIN",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-03-28",
"last_updated": "2018-03-28",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "ND",
"license": "773-17",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.