Individual provider Active NPI

Ansel Garvey

  • Athletic Trainer
  • Worcester, MA
National Provider Identifier
1700160041
Registry record updated Oct 5, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Athletic TrainerTaxonomy code 2255A2300X
License
2235 Issued in MA
Practice address
1 College St
Worcester, MA 01610-2322
Phone
(508) 793-2627
Fax
(508) 793-3974
NPI assigned
Oct 5, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Athletic Trainer 2255A2300X 2235 MA Primary

Addresses

Primary practice location

1 College St
Worcester, MA 01610-2322

Mailing address

15 Wieser Dr
Westfield, MA 01085-5130

Other identifiers 1

IdentifierTypeStateIssuer
2000006552OtherMABOARD 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

LicenseStateTypeSpecialty
2235MAMDRegistered Dietitian

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1317772800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317772800000",
    "number": "1700160041",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 WIESER DR",
            "city": "WESTFIELD",
            "state": "MA",
            "postal_code": "010855130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 COLLEGE ST",
            "city": "WORCESTER",
            "state": "MA",
            "postal_code": "016102322",
            "telephone_number": "508-793-2627",
            "fax_number": "508-793-3974"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARVEY",
        "first_name": "ANSEL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-10-05",
        "last_updated": "2011-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "MA",
            "license": "2235",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BOARD OF CERTIFICATION",
            "identifier": "2000006552",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Worcester, MA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.