Matthew Thomas Jaksetic, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

AT-364 Issued in ID

Practice address

1450 Aviation Dr
201
Hailey, ID 83333-8785

Phone

(208) 727-8281

Fax

(208) 727-8285

NPI assigned

Sep 23, 2009

Last updated

Jun 15, 2010By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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": "1253664000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1276560000000",
    "number": "1366776452",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2561",
            "city": "KETCHUM",
            "state": "ID",
            "postal_code": "833402561",
            "telephone_number": "906-282-4876"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1450 AVIATION DR",
            "address_2": "201",
            "city": "HAILEY",
            "state": "ID",
            "postal_code": "833338785",
            "telephone_number": "208-727-8281",
            "fax_number": "208-727-8285"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JAKSETIC",
        "first_name": "MATTHEW",
        "middle_name": "THOMAS",
        "credential": "ATC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-09-23",
        "last_updated": "2010-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "ID",
            "license": "AT-364",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "WI",
            "license": "959039",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hyperbaric Centers of Idaho LLC (Hyperbarics of Sun Valley)
• Idaho Home Health & Hospice, Inc.
• John Peter Idema, BC-HIS
• John Alan Inman, LMSW
• Casey Mattea Jackson
• Terri Sue James, M.ED.
• Royal William Johnson
• Jones Foot & Ankle LLC
• Tami S Kammer, L.M.F.T., L.C.P.C.
• Emily G Karassik, PA-C

• Athletic Trainer in Hailey, ID
• Providers in Hailey, ID by specialty
• Athletic Trainer in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2010; 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.