Individual provider Active NPI

Matthew Jon Rankin, ATC

  • Athletic Trainer
  • Detroit, MI
National Provider Identifier
1457622169
Registry record updated Jul 18, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
2601000422 Issued in MI
Practice address
2100 Woodward Ave
Detroit, MI 48201-3470
Phone
(419) 304-0485
NPI assigned
Jan 26, 2012
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 18, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X AT1032 OH
Athletic Trainer 2255A2300X 2601000422 MI Primary
Athletic Trainer 2255A2300X AL.2968 FL

Addresses

Primary practice location

2100 Woodward Ave
Detroit, MI 48201-3470

Mailing address

2100 Woodward Ave
Detroit, MI 48201-3470
Phone (419) 304-0485

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

LicenseStateTypeSpecialty
AL.2968FLMDAthletic Trainer
2601000422MIMDAthletic Trainer
AT1032OHMDAthletic Trainer

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1327536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1468800000000",
    "number": "1457622169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 WOODWARD AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482013470",
            "telephone_number": "419-304-0485"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 WOODWARD AVE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482013470",
            "telephone_number": "419-304-0485"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RANKIN",
        "first_name": "MATTHEW",
        "middle_name": "JON",
        "name_prefix": "Mr.",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2012-01-26",
        "last_updated": "2016-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "OH",
            "license": "AT1032",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MI",
            "license": "2601000422",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "FL",
            "license": "AL.2968",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Detroit, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.