Jennifer Lee Shurtz, MS, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

096.002603 Issued in IL

Practice address

3631 S 6TH St
Springfield, IL 62703-4777

Phone

(217) 535-3685

NPI assigned

Jul 18, 2012

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Jennifer Lee Weidman Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1342569600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1342569600000",
    "number": "1609121466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "805 RUTH AVE",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627024841",
            "telephone_number": "217-619-1905"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3631 S 6TH ST",
            "city": "SPRINGFIELD",
            "state": "IL",
            "postal_code": "627034777",
            "telephone_number": "217-535-3685"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHURTZ",
        "first_name": "JENNIFER",
        "middle_name": "LEE",
        "credential": "MS, ATC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-07-18",
        "last_updated": "2012-07-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096.002603",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JENNIFER",
            "last_name": "WEIDMAN",
            "middle_name": "LEE",
            "credential": "MS, ATC",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Shanna Shrum
• Glynnis Ann Shryock, LCPC
• SHS of Springfield Illinois LLC
• Amanda L. Shull, PA-C
• Gary G. Shull, M.D.
• Dmitry Shuster, M.D.
• Keyonna Shutes
• Sapna Siddharth, MD
• Momin Saulat Siddique, M.D.
• Afnan Siddiqui

• Athletic Trainer in Springfield, IL
• Providers in Springfield, IL by specialty
• Athletic Trainer in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 18, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.