Active NPI
Robert Lincoln Woodruff, ATC
- Athletic Trainer
- Ottawa, IL
National Provider Identifier
1497250922
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096.004513
- Practice address
- 1050 E Norris Dr Ste 3
Ottawa, IL 61350-1605 - Phone
- (815) 431-5746
- NPI assigned
- Mar 27, 2018
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 096.004513 | IL | Primary |
Addresses
Primary practice location
1050 E Norris Dr Ste 3
Ottawa, IL 61350-1605
Mailing address
2 Kiley Dr Apt 32
Streator, IL 61364-9787
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 |
|---|---|---|---|
| 096.004513 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1522108800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1522108800000",
"number": "1497250922",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 KILEY DR APT 32",
"city": "STREATOR",
"state": "IL",
"postal_code": "613649787"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1050 E NORRIS DR STE 3",
"city": "OTTAWA",
"state": "IL",
"postal_code": "613501605",
"telephone_number": "815-431-5746"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOODRUFF",
"first_name": "ROBERT",
"middle_name": "LINCOLN",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-03-27",
"last_updated": "2018-03-27",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096.004513",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ottawa, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.