Active NPI
Marc Roy Gamble, ATC
- Athletic Trainer
- Alsip, IL
National Provider Identifier
1720007925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 96001909
- Practice address
- 12052 S Cicero Ave
Alsip, IL 60803-2313 - Phone
- (708) 489-9940
- NPI assigned
- Jul 19, 2006
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Athletic Trainer | 2255A2300X | 96001909 | IL | Primary |
Addresses
Primary practice location
12052 S Cicero Ave
Alsip, IL 60803-2313
Mailing address
790 Remington Blvd
Bolingbrook, IL 60440-4909
Phone (630) 296-2223
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 |
|---|---|---|---|
| 96001909 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280707200000",
"number": "1720007925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "790 REMINGTON BLVD",
"city": "BOLINGBROOK",
"state": "IL",
"postal_code": "604404909",
"telephone_number": "630-296-2223"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12052 S CICERO AVE",
"city": "ALSIP",
"state": "IL",
"postal_code": "608032313",
"telephone_number": "708-489-9940"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GAMBLE",
"first_name": "MARC",
"middle_name": "ROY",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-19",
"last_updated": "2010-08-02",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "96001909",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alsip, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.