Active NPI
Carlos Daniel Luis, ATC
- Athletic Trainer
- Highland, IL
National Provider Identifier
1295160984
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096.003450
- Practice address
- 12603 State Route 143
Ste. #8
Highland, IL 62249-1199 - Phone
- (618) 654-4701
- Fax
- (618) 654-4739
- NPI assigned
- Sep 12, 2013
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 096.003450 | IL | Primary |
| Athletic Trainer | 2255A2300X | 2013023627 | MO |
Addresses
Primary practice location
12603 State Route 143
Ste. #8
Highland, IL 62249-1199
Mailing address
12603 State Route 143
Ste. #8
Highland, IL 62249-1199
Phone (618) 654-4701
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 |
|---|---|---|---|
| 096.003450 | IL | MD | Athletic Trainer |
| 2013023627 | MO | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Phoenix Physical Therapy | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapist
- Swansea, IL
- NPI 1659525368
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1378944000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1378944000000",
"number": "1295160984",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12603 STATE ROUTE 143",
"address_2": "STE. #8",
"city": "HIGHLAND",
"state": "IL",
"postal_code": "622491199",
"telephone_number": "618-654-4701",
"fax_number": "618-654-4739"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12603 STATE ROUTE 143",
"address_2": "STE. #8",
"city": "HIGHLAND",
"state": "IL",
"postal_code": "622491199",
"telephone_number": "618-654-4701",
"fax_number": "618-654-4739"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUIS",
"first_name": "CARLOS",
"middle_name": "DANIEL",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-09-12",
"last_updated": "2013-09-12",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096.003450",
"primary": true
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MO",
"license": "2013023627",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Highland, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.