Active NPI
Marissa Lee Elam, ATC, LAT
- Athletic Trainer
- Indianapolis, IN
National Provider Identifier
1487119970
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 36004117A
- Practice address
- 705 Riley Hospital Dr
Indianapolis, IN 46202-5109 - Phone
- (317) 948-2550
- NPI assigned
- Feb 8, 2019
- Sex
- Female
- 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 | 36004117A | IN | Primary |
Addresses
Primary practice location
705 Riley Hospital Dr
Indianapolis, IN 46202-5109
Mailing address
7116 Foxborough Dr Apt 3D
Lawrence, IN 46226-1212
Phone (765) 716-3708
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 |
|---|---|---|---|
| 36004117A | IN | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1549584000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1769126400000",
"number": "1487119970",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7116 FOXBOROUGH DR APT 3D",
"city": "LAWRENCE",
"state": "IN",
"postal_code": "462261212",
"telephone_number": "765-716-3708"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "705 RILEY HOSPITAL DR",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462025109",
"telephone_number": "317-948-2550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELAM",
"first_name": "MARISSA",
"middle_name": "LEE",
"credential": "ATC, LAT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-02-08",
"last_updated": "2026-01-23",
"certification_date": "2026-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IN",
"license": "36004117A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.