Active NPI
Brett Griesemer, MAED, ATC
- Athletic Trainer
- Blacksburg, VA
National Provider Identifier
1649679788
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 0126001850
- Practice address
- 510 Stadium Rd
160 Jamerson Athletic Center
Blacksburg, VA 24061-1024 - Phone
- (540) 641-3536
- NPI assigned
- Aug 14, 2014
- 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 | 0126001850 | VA | Primary |
Addresses
Primary practice location
510 Stadium Rd
160 Jamerson Athletic Center
Blacksburg, VA 24061-1024
Mailing address
510 Stadium Rd
160 Jamerson Athletic Center
Blacksburg, VA 24061-1024
Phone (540) 641-3536
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0126001850 | Other | VA | ATHLETIC TRAINING STATE LICENSURE |
| 2000003223 | Other | VA | ATHLETIC TRAINING BOARD OF CERTIFICATION |
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 |
|---|---|---|---|
| 0126001850 | VA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1407974400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1407974400000",
"number": "1649679788",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "510 STADIUM RD",
"address_2": "160 JAMERSON ATHLETIC CENTER",
"city": "BLACKSBURG",
"state": "VA",
"postal_code": "240611024",
"telephone_number": "540-641-3536"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 STADIUM RD",
"address_2": "160 JAMERSON ATHLETIC CENTER",
"city": "BLACKSBURG",
"state": "VA",
"postal_code": "240611024",
"telephone_number": "540-641-3536"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRIESEMER",
"first_name": "BRETT",
"credential": "MAED, ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-08-14",
"last_updated": "2014-08-14",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "VA",
"license": "0126001850",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ATHLETIC TRAINING STATE LICENSURE",
"identifier": "0126001850",
"state": "VA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ATHLETIC TRAINING BOARD OF CERTIFICATION",
"identifier": "2000003223",
"state": "VA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Blacksburg, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.