Active NPI
Kyle Roepnack, ATC
- Athletic Trainer
- Herkimer, NY
National Provider Identifier
1265978555
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 000417-1
- Practice address
- 100 Reservoir Rd
Herkimer, NY 13350-1545 - Phone
- (315) 866-0300
- Fax
- (315) 866-1789
- NPI assigned
- Jan 11, 2017
- Last updated
- Jan 11, 2017
- 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 | 000417-1 | NY | Primary |
Addresses
Primary practice location
100 Reservoir Rd
Herkimer, NY 13350-1545
Mailing address
100 Reservoir Rd
Herkimer, NY 13350-1545
Phone (315) 866-0300
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 |
|---|---|---|---|
| 000417-1 | NY | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1484092800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1484092800000",
"number": "1265978555",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 RESERVOIR RD",
"city": "HERKIMER",
"state": "NY",
"postal_code": "133501545",
"telephone_number": "315-866-0300",
"fax_number": "315-866-1789"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 RESERVOIR RD",
"city": "HERKIMER",
"state": "NY",
"postal_code": "133501545",
"telephone_number": "315-866-0300",
"fax_number": "315-866-1789"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROEPNACK",
"first_name": "KYLE",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-01-11",
"last_updated": "2017-01-11",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NY",
"license": "000417-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Herkimer, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.