Active NPI
Justin Patrick Pomar, ATC, LAT
- Athletic Trainer
- Dekalb, IL
National Provider Identifier
1497292973
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096004124
- Practice address
- 1525 W Lincoln Hwy Ste 170
Dekalb, IL 60115-3989 - Phone
- (323) 572-4133
- NPI assigned
- Jan 23, 2017
- Last updated
- Jan 23, 2017
- 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 | 096004124 | IL | Primary |
Addresses
Primary practice location
1525 W Lincoln Hwy Ste 170
Dekalb, IL 60115-3989
Mailing address
1525 W Lincoln Hwy Ste 170
Dekalb, IL 60115-3989
Phone (323) 572-4133
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 |
|---|---|---|---|
| 096004124 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1485129600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1485129600000",
"number": "1497292973",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1525 W LINCOLN HWY STE 170",
"city": "DEKALB",
"state": "IL",
"postal_code": "601153989",
"telephone_number": "323-572-4133"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1525 W LINCOLN HWY STE 170",
"city": "DEKALB",
"state": "IL",
"postal_code": "601153989",
"telephone_number": "323-572-4133"
}
],
"practiceLocations": [],
"basic": {
"last_name": "POMAR",
"first_name": "JUSTIN",
"middle_name": "PATRICK",
"credential": "ATC, LAT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-01-23",
"last_updated": "2017-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096004124",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dekalb, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.