Active NPI
Tracy Gene McCormick, ATC
- Athletic Trainer
- Appleton, WI
National Provider Identifier
1710014824
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 290-039
- Practice address
- 820 E Grant St
Appleton, WI 54911-3483 - Phone
- (920) 831-5050
- Fax
- (920) 738-6400
- NPI assigned
- Feb 27, 2007
- 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 | 290-039 | WI | Primary |
Addresses
Primary practice location
820 E Grant St
Appleton, WI 54911-3483
Mailing address
1904 N Appleton St
Appleton, WI 54911-2737
Phone (920) 882-6595
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 290-039 | Other | WI | STATE LICENSE NUMBER |
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 |
|---|---|---|---|
| 290-039 | WI | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1710014824",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1904 N APPLETON ST",
"city": "APPLETON",
"state": "WI",
"postal_code": "549112737",
"telephone_number": "920-882-6595"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "820 E GRANT ST",
"city": "APPLETON",
"state": "WI",
"postal_code": "549113483",
"telephone_number": "920-831-5050",
"fax_number": "920-738-6400"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCORMICK",
"first_name": "TRACY",
"middle_name": "GENE",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "290-039",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE NUMBER",
"identifier": "290-039",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Appleton, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.