Active NPI
Thomas Jude Reilly, MA, ATC
- Athletic Trainer
- Fremont, NE
National Provider Identifier
1427077965
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 82
- Practice address
- 640 E 22ND St
Fremont, NE 68025-2672 - Phone
- (402) 721-3337
- Fax
- (402) 721-3338
- NPI assigned
- Jul 18, 2006
- 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 | 82 | NE | Primary |
Addresses
Primary practice location
640 E 22ND St
Fremont, NE 68025-2672
Mailing address
207 E Condron St
Valley, NE 68064-3401
Phone (402) 359-4412
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0718080 | Medicaid | IA | |
| 100252598-00 | Medicaid | NE |
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 Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 82 | NE | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153180800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1427077965",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "207 E CONDRON ST",
"city": "VALLEY",
"state": "NE",
"postal_code": "680643401",
"telephone_number": "402-359-4412"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "640 E 22ND ST",
"city": "FREMONT",
"state": "NE",
"postal_code": "680252672",
"telephone_number": "402-721-3337",
"fax_number": "402-721-3338"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REILLY",
"first_name": "THOMAS",
"middle_name": "JUDE",
"credential": "MA, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NE",
"license": "82",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0718080",
"state": "IA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100252598-00",
"state": "NE"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fremont, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.