Active NPI
Shinichiro Sugiura, PH.D., LAT, ATC
- Athletic Trainer
- University Park, PA
National Provider Identifier
1467427104
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- RT007420
- Practice address
- 146 Rec Hall
University Park, PA 16803-1680 - Phone
- (814) 865-8387
- NPI assigned
- Feb 17, 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 36001406A | IN | |
| Athletic Trainer | 2255A2300X | RT007420 | PA | Primary |
Addresses
Primary practice location
146 Rec Hall
University Park, PA 16803-1680
Mailing address
The Pennsylvania State University
146 Rec Hall
University Park, PA 16803-1590
Phone (814) 865-8387
Other practice location 1
1001 E 17th St
Bloomington, IN 47408-1590
Phone (207) 807-7119
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RT007420 | Other | PA | ATHLETIC TRAINER |
| 36001406A | Other | IN | ATHLETIC TRAINER |
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
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36001406A | IN | MD | Athletic Trainer |
| RT007420 | PA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1140134400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1598832000000",
"number": "1467427104",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "THE PENNSYLVANIA STATE UNIVERSITY",
"address_2": "146 REC HALL",
"city": "UNIVERSITY PARK",
"state": "PA",
"postal_code": "168031590",
"telephone_number": "814-865-8387"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "146 REC HALL",
"city": "UNIVERSITY PARK",
"state": "PA",
"postal_code": "168031680",
"telephone_number": "814-865-8387"
}
],
"practiceLocations": [
{
"address_1": "1001 E 17th St",
"address_purpose": "LOCATION",
"city": "Bloomington",
"state": "IN",
"postal_code": "474081590",
"country_code": "US",
"telephone_number": "207-807-7119",
"fax_number": "812-855-1810",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SUGIURA",
"first_name": "SHINICHIRO",
"name_prefix": "Dr.",
"credential": "PH.D., LAT, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-02-17",
"last_updated": "2020-08-31",
"certification_date": "2020-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IN",
"license": "36001406A",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "PA",
"license": "RT007420",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ATHLETIC TRAINER",
"identifier": "RT007420",
"state": "PA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ATHLETIC TRAINER",
"identifier": "36001406A",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in University Park, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.