Jonathan Berridge, LAT ATC OTC

Primary specialty

Orthopedic AssistantTaxonomy code 246ZX2200X

License

17-0629 Issued in PA

Practice address

5201 Pennell Rd Ste C
Media, PA 19063

Phone

(610) 876-0347

NPI assigned

Sep 24, 2015

Last updated

Aug 24, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

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": "1443052800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1535068800000",
    "number": "1336518943",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 MEDICAL CENTER BLVD",
            "city": "CHESTER",
            "state": "PA",
            "postal_code": "190133902"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5201 PENNELL RD STE C",
            "city": "MEDIA",
            "state": "PA",
            "postal_code": "19063",
            "telephone_number": "610-876-0347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BERRIDGE",
        "first_name": "JONATHAN",
        "name_prefix": "Mr.",
        "credential": "LAT ATC OTC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-24",
        "last_updated": "2018-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "PA",
            "license": "RT006128",
            "primary": false
        },
        {
            "code": "246ZX2200X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Other, Orthopedic Assistant",
            "state": "PA",
            "license": "17-0629",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Other Specialist/Technologist in Media, PA
• Providers in Media, PA by specialty
• Other Specialist/Technologist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2018; 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.