Active NPI
Andrew Brubaker
- Athletic Trainer
- Richmond, KY
National Provider Identifier
1457761405
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096.003575
- Practice address
- 113 Susan Way Dr
Richmond, KY 40475-9694 - Phone
- (859) 248-0425
- NPI assigned
- Apr 30, 2014
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Basic Emergency Medical Technician | 146N00000X | 060495082 | IL | |
| Athletic Trainer | 2255A2300X | 096.003575 | IL | Primary |
Addresses
Primary practice location
113 Susan Way Dr
Richmond, KY 40475-9694
Mailing address
113 Susan Way Dr
Richmond, KY 40475-9694
Phone (859) 248-0425
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 |
|---|---|---|---|
| 060495082 | IL | MD | Basic Emergency Medical Technician |
| 096.003575 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1398816000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398816000000",
"number": "1457761405",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "113 SUSAN WAY DR",
"city": "RICHMOND",
"state": "KY",
"postal_code": "404759694",
"telephone_number": "859-248-0425"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "113 SUSAN WAY DR",
"city": "RICHMOND",
"state": "KY",
"postal_code": "404759694",
"telephone_number": "859-248-0425"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUBAKER",
"first_name": "ANDREW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-04-30",
"last_updated": "2014-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "146N00000X",
"taxonomy_group": "",
"desc": "Emergency Medical Technician, Basic",
"state": "IL",
"license": "060495082",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096.003575",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Richmond, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.