Santiago A Segura Barron, MED, LAT, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT-751 Issued in ID

Practice address

Holt Arena 550 Memorial Drive Building 50
Pocatello, ID 83209-0001

Phone

(208) 282-3408

NPI assigned

Jun 23, 2020

Last updated

Jun 23, 2020By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Thania D Segura Barron Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Education

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1592870400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592870400000",
    "number": "1174149389",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "641 W BONNEVILLE ST",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832043338",
            "telephone_number": "641-295-2760"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HOLT ARENA 550 MEMORIAL DRIVE BUILDING 50",
            "city": "POCATELLO",
            "state": "ID",
            "postal_code": "832090001",
            "telephone_number": "208-282-3408"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SEGURA BARRON",
        "first_name": "SANTIAGO",
        "middle_name": "A",
        "credential": "MED, LAT, ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-06-23",
        "last_updated": "2020-06-23",
        "certification_date": "2020-06-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "ID",
            "license": "AT-751",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THANIA",
            "last_name": "SEGURA BARRON",
            "middle_name": "D",
            "credential": "LAT, ATC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Athletic Trainer in Pocatello, ID
• Providers in Pocatello, ID by specialty
• Athletic Trainer in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 23, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.