Active NPI
Walter Trisdale, MS, ATC
- Athletic Trainer
- Worcester, MA
National Provider Identifier
1245685809
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2152
- Practice address
- One College St.
College of the Holy Cross
Worcester, MA 01610 - Phone
- (508) 793-2627
- Fax
- (508) 793-3974
- NPI assigned
- May 2, 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 | 2152 | MA | Primary |
Addresses
Primary practice location
One College St.
College of the Holy Cross
Worcester, MA 01610
Mailing address
One College St.
College of the Holy Cross
Worcester, MA 01610
Phone (508) 793-2627
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 |
|---|---|---|---|
| 2152 | MA | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1462147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1462147200000",
"number": "1245685809",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "ONE COLLEGE ST.",
"address_2": "COLLEGE OF THE HOLY CROSS",
"city": "WORCESTER",
"state": "MA",
"postal_code": "01610",
"telephone_number": "508-793-2627",
"fax_number": "508-793-3974"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "ONE COLLEGE ST.",
"address_2": "COLLEGE OF THE HOLY CROSS",
"city": "WORCESTER",
"state": "MA",
"postal_code": "01610",
"telephone_number": "508-793-2627",
"fax_number": "508-793-3974"
}
],
"practiceLocations": [],
"basic": {
"last_name": "TRISDALE",
"first_name": "WALTER",
"credential": "MS, ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-05-02",
"last_updated": "2016-05-02",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MA",
"license": "2152",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Worcester, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 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.