Michael Patrick Pendergast Sr., ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

Western Illinos University Athletic Dept.
One Univ. Circle
Macomb, IL 61455

Phone

(309) 208-1253

NPI assigned

Apr 20, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1145491200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1275598161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "340 W PIERCE ST",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "614551443",
            "telephone_number": "309-833-5316"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "WESTERN ILLINOS UNIVERSITY ATHLETIC DEPT.",
            "address_2": "ONE UNIV. CIRCLE",
            "city": "MACOMB",
            "state": "IL",
            "postal_code": "61455",
            "telephone_number": "309-208-1253"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PENDERGAST",
        "first_name": "MICHAEL",
        "middle_name": "PATRICK",
        "name_suffix": "Sr.",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-20",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Theodore James Pawlias, D.D.S.
• Lindsay J Peachey, N.C.C.
• Dana Peacock
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• Rachel Ellen Pelton
• Petersen Health Operations, LLC (Countryview Care Center of Macomb)
• Petersen Health Properties, LLC (Coutryview Care Center of Macomb)
• Jennifer M Plos, ATC
• Kathryn Ann Pohlpeter
• Renee L Polubinsky, ATC, CSCS

• Athletic Trainer in Macomb, IL
• Providers in Macomb, IL by specialty
• Athletic Trainer in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; 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.