Active NPI
Joshua Shride, ATC
- Athletic Trainer
- Champaign, IL
National Provider Identifier
1245809870
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096003855
- Practice address
- 2300 S 1St St
Champaign, IL 61820-7661 - Phone
- (217) 383-9400
- NPI assigned
- Jun 18, 2021
- Sex
- Male
- 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 | 096003855 | IL | Primary |
Addresses
Primary practice location
2300 S 1St St
Champaign, IL 61820-7661
Mailing address
2300 S 1St St
Champaign, IL 61820-7661
Phone (217) 383-9400
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 096003855 | Other | IL | IDPH |
| 2000017540 | Other | IL | BOC |
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 |
|---|---|---|---|
| 096003855 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1623974400000",
"number": "1245809870",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2300 S 1ST ST",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618207661",
"telephone_number": "217-383-9400"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 S 1ST ST",
"city": "CHAMPAIGN",
"state": "IL",
"postal_code": "618207661",
"telephone_number": "217-383-9400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHRIDE",
"first_name": "JOSHUA",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-06-18",
"last_updated": "2021-06-18",
"certification_date": "2021-06-18",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096003855",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IDPH",
"identifier": "096003855",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOC",
"identifier": "2000017540",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Champaign, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.