Active NPI
Madeline Grace Ganz, MSAT STUDENT
- Athletic Trainer
- Bloomington, IN
National Provider Identifier
1295440980
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 701 E 17TH St
Bloomington, IN 47408-1578 - Phone
- (812) 855-1966
- NPI assigned
- Jan 18, 2023
- Sex
- Female
- 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 | Primary |
Addresses
Primary practice location
701 E 17TH St
Bloomington, IN 47408-1578
Mailing address
701 E 17TH St
Bloomington, IN 47408-1578
Phone (812) 855-1966
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2000870419 | Other | IN | STUDENT ID |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| SOAP URL | Vivature |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1674000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1674000000000",
"number": "1295440980",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "701 E 17TH ST",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474081578",
"telephone_number": "812-855-1966"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "701 E 17TH ST",
"city": "BLOOMINGTON",
"state": "IN",
"postal_code": "474081578",
"telephone_number": "812-855-1966"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GANZ",
"first_name": "MADELINE",
"middle_name": "GRACE",
"credential": "MSAT STUDENT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-01-18",
"last_updated": "2023-01-18",
"certification_date": "2023-01-18",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STUDENT ID",
"identifier": "2000870419",
"state": "IN"
}
],
"endpoints": [
{
"endpointType": "SOAP",
"endpointTypeDescription": "SOAP URL",
"endpoint": "Vivature",
"affiliation": "N",
"address_1": "701 E 17th St",
"city": "Bloomington",
"state": "IN",
"country_code": "US",
"postal_code": "474081578",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Bloomington, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.