Active NPI
Roger A Doak, AT
- Athletic Trainer
- Portland, MI
National Provider Identifier
1629617402
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2601000486
- Practice address
- 1100 Ionia Rd
Portland, MI 48875-1035 - Phone
- (616) 780-1188
- NPI assigned
- Dec 27, 2019
- 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 | 2601000486 | MI | Primary |
Addresses
Primary practice location
1100 Ionia Rd
Portland, MI 48875-1035
Mailing address
7222 Cedar Ridge Dr
Portland, MI 48875-8678
Phone (616) 780-1188
Other practice location 1
1215 E Michigan Ave
Lansing, MI 48912-1811
Phone (517) 364-1000
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 |
|---|---|---|---|
| 2601000486 | MI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1577404800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1577404800000",
"number": "1629617402",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7222 CEDAR RIDGE DR",
"city": "PORTLAND",
"state": "MI",
"postal_code": "488758678",
"telephone_number": "616-780-1188"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 IONIA RD",
"city": "PORTLAND",
"state": "MI",
"postal_code": "488751035",
"telephone_number": "616-780-1188"
}
],
"practiceLocations": [
{
"address_1": "1215 E Michigan Ave",
"address_purpose": "LOCATION",
"city": "Lansing",
"state": "MI",
"postal_code": "489121811",
"country_code": "US",
"telephone_number": "517-364-1000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "DOAK",
"first_name": "ROGER",
"middle_name": "A",
"name_prefix": "Mr.",
"credential": "AT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-12-27",
"last_updated": "2019-12-27",
"certification_date": "2019-12-27",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MI",
"license": "2601000486",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 27, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.