Active NPI
Jessica Meacham, ATC
- Athletic Trainer
- Bolingbrook, IL
National Provider Identifier
1508356403
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2391
- Practice address
- 790 Remington Blvd
Bolingbrook, IL 60440-4909 - Phone
- (630) 296-2223
- NPI assigned
- May 16, 2018
- 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 | 2391 | AL | Primary |
Addresses
Primary practice location
790 Remington Blvd
Bolingbrook, IL 60440-4909
Mailing address
2114 Springfield Dr
Chelsea, AL 35043-2029
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| VWM00002353C | Other | BLUE CROSS BLUE SHIELD |
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 |
|---|---|---|---|
| 2391 | AL | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1526428800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1673136000000",
"number": "1508356403",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2114 SPRINGFIELD DR",
"city": "CHELSEA",
"state": "AL",
"postal_code": "350432029"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "790 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404909",
"telephone_number": "630-296-2223"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEACHAM",
"first_name": "JESSICA",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-05-16",
"last_updated": "2023-01-08",
"certification_date": "2023-01-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "AL",
"license": "2391",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "VWM00002353C",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Bolingbrook, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.