Active NPI
Josue David Villacis
- Athletic Trainer
- Chicago, IL
National Provider Identifier
1386453124
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096004155
- Practice address
- 5530 S Ellis Ave
Chicago, IL 60637-1402 - Phone
- (773) 858-0330
- NPI assigned
- Jan 6, 2025
- 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 | 096004155 | IL | Primary |
Addresses
Primary practice location
5530 S Ellis Ave
Chicago, IL 60637-1402
Mailing address
5412 N Kenmore Ave Apt 1W
Chicago, IL 60640-1810
Phone (773) 858-0330
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 |
|---|---|---|---|
| 096004155 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1736121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736121600000",
"number": "1386453124",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5412 N KENMORE AVE APT 1W",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606401810",
"telephone_number": "773-858-0330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5530 S ELLIS AVE",
"city": "CHICAGO",
"state": "IL",
"postal_code": "606371402",
"telephone_number": "773-858-0330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VILLACIS",
"first_name": "JOSUE",
"middle_name": "DAVID",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-01-06",
"last_updated": "2025-01-06",
"certification_date": "2025-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096004155",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Chicago, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.