Active NPI
Jonathan William Crocker, MS ATC PED
- Athletic Trainer
- Everett, MA
National Provider Identifier
1598138539
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2228
- Practice address
- 33 Clarence St Apt 2
Everett, MA 02149-5141 - Phone
- (617) 637-6864
- NPI assigned
- Nov 12, 2015
- Last updated
- Nov 12, 2015
- 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 | 2228 | MA | Primary |
Addresses
Primary practice location
33 Clarence St Apt 2
Everett, MA 02149-5141
Mailing address
33 Clarence St Apt 2
Everett, MA 02149-5141
Phone (617) 637-6864
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2228 | MA | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1447286400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1447286400000",
"number": "1598138539",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "33 CLARENCE ST APT 2",
"city": "EVERETT",
"state": "MA",
"postal_code": "021495141",
"telephone_number": "617-637-6864"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "33 CLARENCE ST APT 2",
"city": "EVERETT",
"state": "MA",
"postal_code": "021495141",
"telephone_number": "617-637-6864"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CROCKER",
"first_name": "JONATHAN",
"middle_name": "WILLIAM",
"credential": "MS ATC PED",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-11-12",
"last_updated": "2015-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MA",
"license": "2228",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Everett, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.