Active NPI
Philip Ray Nickols
- Athletic Trainer
- Macomb, IL
National Provider Identifier
1407370729
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096.003810
- Practice address
- 1 University Cir
Macomb, IL 61455 - Phone
- (309) 298-2138
- NPI assigned
- Jul 28, 2017
- Last updated
- Jul 21, 2022
- 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 | 096.003810 | IL | Primary |
Addresses
Primary practice location
1 University Cir
Macomb, IL 61455
Mailing address
1 University Cir
Macomb, IL 61455-1367
Phone (309) 298-2138
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 |
|---|---|---|---|
| 096.003810 | IL | MD | Athletic Trainer |
Interoperability endpoints
- philip.nickols.1@28977.direct.athenahealth.com
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1501200000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1658361600000",
"number": "1407370729",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 UNIVERSITY CIR",
"city": "MACOMB",
"state": "IL",
"postal_code": "614551367",
"telephone_number": "309-298-2138"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 UNIVERSITY CIR",
"city": "MACOMB",
"state": "IL",
"postal_code": "61455",
"telephone_number": "309-298-2138"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICKOLS",
"first_name": "PHILIP",
"middle_name": "RAY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-07-28",
"last_updated": "2022-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096.003810",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Macomb, IL
- Mosaic
- Rebecca Sue Mowers, MSW, LSW
- Reghan L Mulder
- Rajan S Mullangi, MD
- New Directions Counseling Services LLC
- North Central Behavioral Health Systems Inc.
- North Central Behavioral Health Systems, Inc.
- Northland Hearing Centers, Inc (Hearing Healthcare Associates)
- Northland Hearing Centers, Inc. (Northland Hearing Centers, Inc. dba Hearing Health Care Associates)
- Omaha Vamc
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.