Active NPI
Melissa Brungard
- Athletic Trainer
- Seneca, IL
National Provider Identifier
1508260308
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096.003095
- Practice address
- 364 Seneca Place
Seneca, IL 61360 - Phone
- (217) 244-4921
- NPI assigned
- Oct 22, 2014
- 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 | 096.003095 | IL | Primary |
Addresses
Primary practice location
364 Seneca Place
Seneca, IL 61360
Mailing address
364 Seneca PL
Seneca, IL 61360-9681
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 |
|---|---|---|---|
| 096.003095 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1413936000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1431302400000",
"number": "1508260308",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "364 SENECA PL",
"city": "SENECA",
"state": "IL",
"postal_code": "613609681"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "364 SENECA PLACE",
"city": "SENECA",
"state": "IL",
"postal_code": "61360",
"telephone_number": "217-244-4921"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRUNGARD",
"first_name": "MELISSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-10-22",
"last_updated": "2015-05-11",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096.003095",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Seneca, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.