Benjamin Tate Jr., MS, ATC

Primary specialty

Sports Medicine (Physical Medicine & Rehabilitation) PhysicianTaxonomy code 2081S0010X

License

AT004792 Issued in OH

Practice address

100 W College St
Granville, OH 43023-1100

Phone

(740) 587-5063

NPI assigned

Jul 4, 2020

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1593820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1593820800000",
    "number": "1477170603",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "126 ANDOVER RD APT C",
            "city": "HEATH",
            "state": "OH",
            "postal_code": "430561394",
            "telephone_number": "814-823-2482"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 W COLLEGE ST",
            "city": "GRANVILLE",
            "state": "OH",
            "postal_code": "430231100",
            "telephone_number": "740-587-5063"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "TATE",
        "first_name": "BENJAMIN",
        "name_suffix": "Jr.",
        "credential": "MS, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-04",
        "last_updated": "2020-07-04",
        "certification_date": "2020-07-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2081S0010X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation, Sports Medicine",
            "state": "OH",
            "license": "AT004792",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kaylie J Spangler
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• Michaela Stopar, DPT
• Christy Tracy Stricker, RPH
• Aleksandar Tancevski, MD
• Stacie Thaxton, LPCC, NCC
• The Play Connection, LLC
• Debra L Thomas, RN
• Mary T. Thurlow-Collen, CNP
• Timothy J. McNeish, PH. D. LLC

• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Granville, OH
• Providers in Granville, OH by specialty
• Sports Medicine (Physical Medicine & Rehabilitation) Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 4, 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.

Verify at the official NPI Registry.