Active NPI
Matthew R Davis, ATC
- Athletic Trainer
- Wilmington, OH
National Provider Identifier
1497949036
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT-000991
- Practice address
- 610 W Main St
Wilmington, OH 45177-2125 - Phone
- (937) 383-7722
- NPI assigned
- Aug 28, 2007
- 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 | AT-000991 | OH | Primary |
Addresses
Primary practice location
610 W Main St
Wilmington, OH 45177-2125
Mailing address
1111 Deerfield Rd Unit 402
Lebanon, OH 45036-7113
Phone (513) 282-2155
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 |
|---|---|---|---|
| AT-000991 | OH | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1188259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1188259200000",
"number": "1497949036",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1111 DEERFIELD RD UNIT 402",
"city": "LEBANON",
"state": "OH",
"postal_code": "450367113",
"telephone_number": "513-282-2155"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "610 W MAIN ST",
"city": "WILMINGTON",
"state": "OH",
"postal_code": "451772125",
"telephone_number": "937-383-7722"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DAVIS",
"first_name": "MATTHEW",
"middle_name": "R",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-08-28",
"last_updated": "2007-08-28",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OH",
"license": "AT-000991",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 28, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.