Active NPI
Vincent John Di Renzo, MAT,ATC,CSCS
- Athletic Trainer
- McHenry, IL
National Provider Identifier
1578993424
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096.003644
- Practice address
- 1783 Richmond Avenue
McHenry, IL 60050 - Phone
- (815) 385-0730
- Fax
- (815) 385-0572
- NPI assigned
- Nov 13, 2013
- 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 | 096.003644 | IL | Primary |
Addresses
Primary practice location
1783 Richmond Avenue
McHenry, IL 60050
Mailing address
13468 Delaney Rd
Huntley, IL 60142-6334
Phone (815) 354-5667
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 |
|---|---|---|---|
| 096.003644 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1384300800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1384300800000",
"number": "1578993424",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13468 DELANEY RD",
"city": "HUNTLEY",
"state": "IL",
"postal_code": "601426334",
"telephone_number": "815-354-5667",
"fax_number": "815-943-8008"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1783 RICHMOND AVENUE",
"city": "MCHENRY",
"state": "IL",
"postal_code": "60050",
"telephone_number": "815-385-0730",
"fax_number": "815-385-0572"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DI RENZO",
"first_name": "VINCENT",
"middle_name": "JOHN",
"name_prefix": "Mr.",
"credential": "MAT,ATC,CSCS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-11-13",
"last_updated": "2013-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096.003644",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in McHenry, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.