Active NPI
Samantha Melillo
- Athletic Trainer
- Lake Villa, IL
National Provider Identifier
1346796778
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 2070 Oak Tree TRL
Lake Villa, IL 60046-7569 - Phone
- (224) 436-0066
- NPI assigned
- Aug 26, 2016
- Sex
- Female
- Sole proprietor
- Yes
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
2070 Oak Tree TRL
Lake Villa, IL 60046-7569
Mailing address
2070 Oak Tree TRL
Lake Villa, IL 60046-7569
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 390200000X | Other | OH | STUDENT IN AN ORGANIZED TRAINING HEALTHCARE ORGANIZATION TRAINING PROGRAM |
| 2255A2300X | Other | OH | SPECIALIST/TECHNOLOGIST-ATHLETIC TRAINER |
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": "1472169600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1472169600000",
"number": "1346796778",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2070 OAK TREE TRL",
"city": "LAKE VILLA",
"state": "IL",
"postal_code": "600467569"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2070 OAK TREE TRL",
"city": "LAKE VILLA",
"state": "IL",
"postal_code": "600467569",
"telephone_number": "224-436-0066"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MELILLO",
"first_name": "SAMANTHA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-08-26",
"last_updated": "2016-08-26",
"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 IN AN ORGANIZED TRAINING HEALTHCARE ORGANIZATION TRAINING PROGRAM",
"identifier": "390200000X",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SPECIALIST/TECHNOLOGIST-ATHLETIC TRAINER",
"identifier": "2255A2300X",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lake Villa, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.