NPIMap

Individual provider Active NPI

Joseph Hacker III, ATC, MED, CSCS

  • Athletic Trainer
  • Independence, KY
National Provider Identifier
1376993204
Registry record updated Jun 22, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
AT803 Issued in KY
Practice address
1918 Declaration Dr
Independence, KY 41051-7931
Phone
(859) 356-0179
NPI assigned
Jun 22, 2016
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 22, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X AT803 KY Primary

Addresses

Primary practice location

1918 Declaration Dr
Independence, KY 41051-7931

Mailing address

1918 Declaration Dr
Independence, KY 41051-7931
Phone (859) 356-0179

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
Credentials
Master of Education

State licenses

LicenseStateTypeSpecialty
AT803KYMDAthletic Trainer

Practice roles

OrganizationSpecialtyStatusNew patients
Kentucky Rehabilitation Services Inc Past Accepting new patients
Kentucky Rehabilitation Services Inc Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1466553600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1466553600000",
    "number": "1376993204",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1918 DECLARATION DR",
            "city": "INDEPENDENCE",
            "state": "KY",
            "postal_code": "410517931",
            "telephone_number": "859-356-0179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1918 DECLARATION DR",
            "city": "INDEPENDENCE",
            "state": "KY",
            "postal_code": "410517931",
            "telephone_number": "859-356-0179"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HACKER",
        "first_name": "JOSEPH",
        "name_prefix": "Mr.",
        "name_suffix": "III",
        "credential": "ATC, MED, CSCS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-06-22",
        "last_updated": "2016-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "KY",
            "license": "AT803",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Independence, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 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.

Verify at the official NPI Registry.