Active NPI
Samantha Judith Desjardine, MSED LAT ATC
- Athletic Trainer
- Naperville, IL
National Provider Identifier
1467169797
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096.004839
- Practice address
- 100 Spalding Dr Ste 300
Naperville, IL 60540-6553 - Phone
- (630) 790-1872
- NPI assigned
- Nov 7, 2022
- Sex
- Female
- 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 | 096.004839 | IL | Primary |
Addresses
Primary practice location
100 Spalding Dr Ste 300
Naperville, IL 60540-6553
Mailing address
2245 Copley St
Aurora, IL 60506-3248
Phone (630) 818-0517
Other practice location 1
1 Mayor Art Schultz Dr
Joliet, IL 60432-4092
Phone (630) 818-0517
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Epic |
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 |
|---|---|---|---|
| 096.004839 | IL | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dupage Medical Group LTD | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
dba DuPage Medical Group
- Multi-Specialty Clinic/Center
- Downers Grove, IL
- NPI 1801833983
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1667779200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1667779200000",
"number": "1467169797",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2245 COPLEY ST",
"city": "AURORA",
"state": "IL",
"postal_code": "605063248",
"telephone_number": "630-818-0517"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 SPALDING DR STE 300",
"city": "NAPERVILLE",
"state": "IL",
"postal_code": "605406553",
"telephone_number": "630-790-1872"
}
],
"practiceLocations": [
{
"address_1": "1 Mayor Art Schultz Dr",
"address_purpose": "LOCATION",
"city": "Joliet",
"state": "IL",
"postal_code": "604324092",
"country_code": "US",
"telephone_number": "630-818-0517",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DESJARDINE",
"first_name": "SAMANTHA",
"middle_name": "JUDITH",
"credential": "MSED LAT ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-11-07",
"last_updated": "2022-11-07",
"certification_date": "2022-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096.004839",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Epic",
"affiliation": "N",
"address_1": "100 Spalding Dr Ste 300",
"city": "Naperville",
"state": "IL",
"country_code": "US",
"postal_code": "605406553",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Naperville, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 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.