Active NPI
Jacob White
- Athletic Trainer
- Boston, MA
National Provider Identifier
1194289892
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 580 Commonwealth Ave Unit 501
Boston, MA 02215-2509 - Phone
- (415) 847-7105
- NPI assigned
- Jan 27, 2019
- 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 | Primary |
Addresses
Primary practice location
580 Commonwealth Ave Unit 501
Boston, MA 02215-2509
Mailing address
580 Commonwealth Ave Unit 501
Boston, MA 02215-2509
Phone (415) 847-7105
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1548547200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1548547200000",
"number": "1194289892",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "580 COMMONWEALTH AVE UNIT 501",
"city": "BOSTON",
"state": "MA",
"postal_code": "022152509",
"telephone_number": "415-847-7105"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "580 COMMONWEALTH AVE UNIT 501",
"city": "BOSTON",
"state": "MA",
"postal_code": "022152509",
"telephone_number": "415-847-7105"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WHITE",
"first_name": "JACOB",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-01-27",
"last_updated": "2019-01-27",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boston, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.