Active NPI
Edward Robert Bartlett, A.T,C. L.A.T.
- Athletic Trainer
- Brent, AL
National Provider Identifier
1508823378
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT 0589
- Practice address
- 176 CCC Camp Rd
Brent, AL 35034-2650 - Phone
- (205) 225-0779
- NPI assigned
- Apr 27, 2006
- Last updated
- Jul 8, 2007
- 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 | AT 0589 | TX | Primary |
Addresses
Primary practice location
176 CCC Camp Rd
Brent, AL 35034-2650
Mailing address
176 CCC Camp Rd
Brent, AL 35034-2650
Phone (205) 225-0779
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| AT0589 | Other | TX | LICENSED ATHLETIC TRAINER |
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 0589 | TX | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146096000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1508823378",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "176 CCC CAMP RD",
"city": "BRENT",
"state": "AL",
"postal_code": "350342650",
"telephone_number": "205-225-0779"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "176 CCC CAMP RD",
"city": "BRENT",
"state": "AL",
"postal_code": "350342650",
"telephone_number": "205-225-0779"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BARTLETT",
"first_name": "EDWARD",
"middle_name": "ROBERT",
"name_prefix": "Mr.",
"credential": "A.T,C. L.A.T.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-04-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TX",
"license": "AT 0589",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSED ATHLETIC TRAINER",
"identifier": "AT0589",
"state": "TX"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brent, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.