Active NPI
Paige Doherty
- Athletic Trainer
- Peoria, IL
National Provider Identifier
1548123334
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096.005981
- Practice address
- 1501 W Bradley Ave
Peoria, IL 61625-0001 - Phone
- (224) 239-7161
- NPI assigned
- Dec 8, 2025
- Last updated
- Dec 8, 2025
- 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 | 096.005981 | IL | Primary |
Addresses
Primary practice location
1501 W Bradley Ave
Peoria, IL 61625-0001
Mailing address
1700 Marigold Ave
Apt 5211
Peoria, IL 61615
Phone (224) 239-7161
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 |
|---|---|---|---|
| 096.005981 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1765152000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1765152000000",
"number": "1548123334",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1700 MARIGOLD AVE",
"address_2": "APT 5211",
"city": "PEORIA",
"state": "IL",
"postal_code": "61615",
"telephone_number": "224-239-7161"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 W BRADLEY AVE",
"city": "PEORIA",
"state": "IL",
"postal_code": "616250001",
"telephone_number": "224-239-7161"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DOHERTY",
"first_name": "PAIGE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-12-08",
"last_updated": "2025-12-08",
"certification_date": "2025-12-01",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096.005981",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.