Trevor Glenn Addison, ATC

Primary specialty

Sports Medicine (Emergency Medicine) PhysicianTaxonomy code 207PS0010X

License

2000026911 Issued in CA

Practice address

1620 Pajaro CT.
Fremont, CA 94539

Phone

(510) 673-2085

NPI assigned

Jun 8, 2017

Sex

Male

Sole proprietor

Yes

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": "1496880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1295264653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1620 PAJARO CT",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "945394430",
            "telephone_number": "510-673-2085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1620 PAJARO CT.",
            "city": "FREMONT",
            "state": "CA",
            "postal_code": "94539",
            "telephone_number": "510-673-2085"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ADDISON",
        "first_name": "TREVOR",
        "middle_name": "GLENN",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-06-08",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PS0010X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Emergency Medicine, Sports Medicine",
            "state": "CA",
            "license": "2000026911",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Sports Medicine (Emergency Medicine) Physician in Fremont, CA
• Providers in Fremont, CA by specialty
• Sports Medicine (Emergency Medicine) Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.