Active NPI
Cody Robert Gibson I, ATC
- Athletic Trainer
- Modesto, CA
National Provider Identifier
1699164459
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 4318 Spyres Way
Modesto, CA 95356-9259 - Phone
- (209) 576-0710
- Fax
- (209) 576-7283
- NPI assigned
- Jan 16, 2015
- 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 | Primary |
Addresses
Primary practice location
4318 Spyres Way
Modesto, CA 95356-9259
Mailing address
1800 Ronald CT
Modesto, CA 95350-2844
Phone (209) 815-0039
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| ZZZ03337Z | Other | CA | MEDICARE |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Golden Bear Physical Therapy Sports Injury Center, Inc | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Physical Therapy Clinic/Center
- Modesto, CA
- NPI 1811084676
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421366400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421366400000",
"number": "1699164459",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 RONALD CT",
"city": "MODESTO",
"state": "CA",
"postal_code": "953502844",
"telephone_number": "209-815-0039"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4318 SPYRES WAY",
"city": "MODESTO",
"state": "CA",
"postal_code": "953569259",
"telephone_number": "209-576-0710",
"fax_number": "209-576-7283"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GIBSON",
"first_name": "CODY",
"middle_name": "ROBERT",
"name_prefix": "Mr.",
"name_suffix": "I",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2015-01-16",
"last_updated": "2015-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE",
"identifier": "ZZZ03337Z",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Modesto, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.