Active NPI
Timothy James Bass, ATC, LAT, CES
- Athletic Trainer
- Provo, UT
National Provider Identifier
1609389311
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 6123836-4810
- Practice address
- 1143 SFH
Provo, UT 84602-2246 - Phone
- (801) 422-0974
- NPI assigned
- Nov 16, 2017
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 1560 | TN | |
| Athletic Trainer | 2255A2300X | 6123836-4810 | UT | Primary |
Addresses
Primary practice location
1143 SFH
Provo, UT 84602-2246
Mailing address
1143 SFH
Provo, UT 84602-2246
Phone (805) 760-8213
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 |
|---|---|---|---|
| 1560 | TN | MD | Athletic Trainer |
| 6123836-4810 | UT | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1510790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654214400000",
"number": "1609389311",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1143 SFH",
"city": "PROVO",
"state": "UT",
"postal_code": "846022246",
"telephone_number": "805-760-8213"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1143 SFH",
"city": "PROVO",
"state": "UT",
"postal_code": "846022246",
"telephone_number": "801-422-0974"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BASS",
"first_name": "TIMOTHY",
"middle_name": "JAMES",
"name_prefix": "Mr.",
"credential": "ATC, LAT, CES",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-11-16",
"last_updated": "2022-06-03",
"certification_date": "2022-06-03",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TN",
"license": "1560",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "UT",
"license": "6123836-4810",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Provo, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 3, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.