Active NPI
Peter Smith, ATC
- Athletic Trainer
- Bridgewater, MA
National Provider Identifier
1407360258
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AH748AT
- Practice address
- 415 Center St
Bridgewater, MA 02324-1309 - Phone
- (508) 697-6902
- NPI assigned
- Nov 30, 2017
- Sex
- Male
- Sole proprietor
- No
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 | AH748AT | MA | Primary |
Addresses
Primary practice location
415 Center St
Bridgewater, MA 02324-1309
Mailing address
415 Center St
Bridgewater, MA 02324-1309
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AH748AT | Other | MA | ALLIED HEALTH STATE LICENSE |
| AH748AT | Other | MA | STATE OF MASSACHUSETTS ALLIED HEALTH LICENSE NUMBER |
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 |
|---|---|---|---|
| AH748AT | MA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1512000000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1529107200000",
"number": "1407360258",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "415 CENTER ST",
"city": "BRIDGEWATER",
"state": "MA",
"postal_code": "023241309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "415 CENTER ST",
"city": "BRIDGEWATER",
"state": "MA",
"postal_code": "023241309",
"telephone_number": "508-697-6902"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMITH",
"first_name": "PETER",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-11-30",
"last_updated": "2018-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MA",
"license": "AH748AT",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ALLIED HEALTH STATE LICENSE",
"identifier": "AH748AT",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE OF MASSACHUSETTS ALLIED HEALTH LICENSE NUMBER",
"identifier": "AH748AT",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Bridgewater, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 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.