Active NPI
Broden Schock, AT
- Athletic Trainer
- Amery, WI
National Provider Identifier
1578181657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2168-39
- Practice address
- 220 Keller Ave N
Amery, WI 54001-1036 - Phone
- (715) 268-1008
- NPI assigned
- Jul 6, 2020
- 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 | 2168-39 | WI | Primary |
Addresses
Primary practice location
220 Keller Ave N
Amery, WI 54001-1036
Mailing address
1503 85TH Ave
Amery, WI 54001-4947
Phone (715) 557-1086
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 |
|---|---|---|---|
| 2168-39 | WI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1593993600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593993600000",
"number": "1578181657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1503 85TH AVE",
"city": "AMERY",
"state": "WI",
"postal_code": "540014947",
"telephone_number": "715-557-1086"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "220 KELLER AVE N",
"city": "AMERY",
"state": "WI",
"postal_code": "540011036",
"telephone_number": "715-268-1008"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SCHOCK",
"first_name": "BRODEN",
"credential": "AT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2020-07-06",
"last_updated": "2020-07-06",
"certification_date": "2020-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "2168-39",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Amery, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.