Active NPI
Sean Gough
- Athletic Trainer
- Oshkosh, WI
National Provider Identifier
1689396715
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2425-39
- Practice address
- 1100 W Smith Ave
Oshkosh, WI 54901-1848 - Phone
- (920) 424-7000
- NPI assigned
- Sep 15, 2022
- 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 | 2431 | MN | |
| Athletic Trainer | 2255A2300X | 2425-39 | WI | Primary |
Addresses
Primary practice location
1100 W Smith Ave
Oshkosh, WI 54901-1848
Mailing address
1214 Stead Dr
Menasha, WI 54952-2191
Phone (763) 313-6341
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 |
|---|---|---|---|
| 2431 | MN | MD | Athletic Trainer |
| 2425-39 | WI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663200000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1663200000000",
"number": "1689396715",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1214 STEAD DR",
"city": "MENASHA",
"state": "WI",
"postal_code": "549522191",
"telephone_number": "763-313-6341"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1100 W SMITH AVE",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549011848",
"telephone_number": "920-424-7000"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOUGH",
"first_name": "SEAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-09-15",
"last_updated": "2022-09-15",
"certification_date": "2022-09-15",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MN",
"license": "2431",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "2425-39",
"primary": true
}
],
"identifiers": [],
"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 Sep 15, 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.