Active NPI
Benjamin William Spencer Elliott, ATC
- Athletic Trainer
- Pelham, AL
National Provider Identifier
1376095737
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1939
- Practice address
- 114 Grand Reserve Dr
Pelham, AL 35124-1272 - Phone
- (256) 591-0017
- NPI assigned
- Nov 1, 2016
- Sex
- Male
- 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 | 1939 | AL | Primary |
Addresses
Primary practice location
114 Grand Reserve Dr
Pelham, AL 35124-1272
Mailing address
5037 Red Oak Dr
Oxford, AL 36203-3350
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 |
|---|---|---|---|
| 1939 | AL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1477958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1521676800000",
"number": "1376095737",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5037 RED OAK DR",
"city": "OXFORD",
"state": "AL",
"postal_code": "362033350"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "114 GRAND RESERVE DR",
"city": "PELHAM",
"state": "AL",
"postal_code": "351241272",
"telephone_number": "256-591-0017"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIOTT",
"first_name": "BENJAMIN",
"middle_name": "WILLIAM SPENCER",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-11-01",
"last_updated": "2018-03-22",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "AL",
"license": "1939",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pelham, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 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.