Active NPI
Summer Bloom Runestad, ATC
- Athletic Trainer
- Los Angeles, CA
National Provider Identifier
1376019919
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 120502018
- Practice address
- 403 W Adams Blvd
Los Angeles, CA 90007-2664 - Phone
- (213) 910-3526
- Fax
- (213) 741-8324
- NPI assigned
- Oct 22, 2018
- 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 | 120502018 | CA | Primary |
Addresses
Primary practice location
403 W Adams Blvd
Los Angeles, CA 90007-2664
Mailing address
403 W Adams Blvd
Los Angeles, CA 90007-2664
Phone (213) 910-3526
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 120502018 | CA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1540166400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1540166400000",
"number": "1376019919",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "403 W ADAMS BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900072664",
"telephone_number": "213-910-3526",
"fax_number": "213-741-8324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "403 W ADAMS BLVD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900072664",
"telephone_number": "213-910-3526",
"fax_number": "213-741-8324"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RUNESTAD",
"first_name": "SUMMER",
"middle_name": "BLOOM",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-10-22",
"last_updated": "2018-10-22",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "CA",
"license": "120502018",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 22, 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.