Active NPI
Bradley R Smith, MS, ATC
- Athletic Trainer
- University Center, MI
National Provider Identifier
1669837662
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2601001899
- Practice address
- 7400 Bay Rd
University Center, MI 48710-0001 - Phone
- (989) 964-2121
- Fax
- (989) 964-7389
- NPI assigned
- Dec 18, 2015
- Sex
- Male
- Sole proprietor
- Yes
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 | AT1219 | KY | |
| Athletic Trainer | 2255A2300X | 2601001899 | MI | Primary |
Addresses
Primary practice location
7400 Bay Rd
University Center, MI 48710-0001
Mailing address
7400 Bay Rd
University Center, MI 48710-0001
Phone (517) 605-4524
Other practice location 1
Berea College Cpo 2187
Berea, KY 40404-0001
Phone (859) 985-4293
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | brsmith2@svsu.edu | Direct |
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
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AT1219 | KY | MD | Athletic Trainer |
| 2601001899 | MI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1450396800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1626825600000",
"number": "1669837662",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7400 BAY RD",
"city": "UNIVERSITY CENTER",
"state": "MI",
"postal_code": "487100001",
"telephone_number": "517-605-4524",
"fax_number": "989-964-7389"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7400 BAY RD",
"city": "UNIVERSITY CENTER",
"state": "MI",
"postal_code": "487100001",
"telephone_number": "989-964-2121",
"fax_number": "989-964-7389"
}
],
"practiceLocations": [
{
"address_1": "Berea College Cpo 2187",
"address_purpose": "LOCATION",
"city": "Berea",
"state": "KY",
"postal_code": "404040001",
"country_code": "US",
"telephone_number": "859-985-4293",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "SMITH",
"first_name": "BRADLEY",
"middle_name": "R",
"credential": "MS, ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-12-18",
"last_updated": "2021-07-21",
"certification_date": "2021-07-21",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "KY",
"license": "AT1219",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MI",
"license": "2601001899",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "brsmith2@svsu.edu",
"affiliation": "N",
"endpointDescription": "Employer Email Address",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "7400 Bay Rd",
"city": "University Center",
"state": "MI",
"country_code": "US",
"postal_code": "487100001",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in University Center, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 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.