Active NPI
Gerald Mickler, LAT, ATC
- Athletic Trainer
- Indianapolis, IN
National Provider Identifier
1417279969
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 36001951A
- Practice address
- 9500 E 16TH St
Indianapolis, IN 46229-2008 - Phone
- (317) 532-6200
- NPI assigned
- Feb 25, 2010
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Sports Medicine (Physical Medicine & Rehabilitation) Physician | 2081S0010X | 0849 | AZ | |
| Athletic Trainer | 2255A2300X | 36001951A | IN | Primary |
Addresses
Primary practice location
9500 E 16TH St
Indianapolis, IN 46229-2008
Mailing address
19173 Roudebush Blvd
Noblesville, IN 46060-7632
Phone (317) 385-1345
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 |
|---|---|---|---|
| 0849 | AZ | MD | Sports Medicine (Physical Medicine & Rehabilitation) Physician |
| 36001951A | IN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1267056000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1720483200000",
"number": "1417279969",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19173 ROUDEBUSH BLVD",
"city": "NOBLESVILLE",
"state": "IN",
"postal_code": "460607632",
"telephone_number": "317-385-1345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9500 E 16TH ST",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462292008",
"telephone_number": "317-532-6200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MICKLER",
"first_name": "GERALD",
"credential": "LAT, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-02-25",
"last_updated": "2024-07-09",
"certification_date": "2024-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "2081S0010X",
"taxonomy_group": "",
"desc": "Physical Medicine & Rehabilitation, Sports Medicine",
"state": "AZ",
"license": "0849",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IN",
"license": "36001951A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.