Active NPI
Raven Gmach, LAT, ATC
- Athletic Trainer
- Oshkosh, WI
National Provider Identifier
1619488012
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2424-39
- Practice address
- 800 Algoma Blvd
Oshkosh, WI 54901-3551 - Phone
- (920) 917-5773
- NPI assigned
- Oct 12, 2017
- Sex
- Female
- 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 | |||
| Athletic Trainer | 2255A2300X | 2424-39 | WI | Primary |
Addresses
Primary practice location
800 Algoma Blvd
Oshkosh, WI 54901-3551
Mailing address
800 Algoma Blvd
Oshkosh, WI 54901-3551
Phone (920) 917-5773
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2424-39 | Other | WI | DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES |
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 |
|---|---|---|---|
| 2424-39 | WI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507766400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1624320000000",
"number": "1619488012",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "800 ALGOMA BLVD",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549013551",
"telephone_number": "920-917-5773"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "800 ALGOMA BLVD",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549013551",
"telephone_number": "920-917-5773"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GMACH",
"first_name": "RAVEN",
"credential": "LAT, ATC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-10-12",
"last_updated": "2021-06-22",
"certification_date": "2021-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "2424-39",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DEPARTMENT OF SAFETY AND PROFESSIONAL SERVICES",
"identifier": "2424-39",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Oshkosh, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.