Active NPI
Bryan George Demaine, ATC
- Athletic Trainer
- Saint Cloud, MN
National Provider Identifier
1477183192
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 1576
- Practice address
- 720 4TH Ave S # 133
Saint Cloud, MN 56301-4498 - Phone
- (320) 308-2588
- NPI assigned
- Jan 22, 2020
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 1576 | MN | Primary |
Addresses
Primary practice location
720 4TH Ave S # 133
Saint Cloud, MN 56301-4498
Mailing address
3087 Olympus Dr NE
Sauk Rapids, MN 56379-4411
Phone (320) 247-3330
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 |
|---|---|---|---|
| 1576 | MN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1579651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1579651200000",
"number": "1477183192",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3087 OLYMPUS DR NE",
"city": "SAUK RAPIDS",
"state": "MN",
"postal_code": "563794411",
"telephone_number": "320-247-3330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "720 4TH AVE S # 133",
"city": "SAINT CLOUD",
"state": "MN",
"postal_code": "563014498",
"telephone_number": "320-308-2588"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEMAINE",
"first_name": "BRYAN",
"middle_name": "GEORGE",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-01-22",
"last_updated": "2020-01-22",
"certification_date": "2020-01-22",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MN",
"license": "1576",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Cloud, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 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.