Active NPI
Clyde Donald Hastings III, LAT, ATC
- Athletic Trainer
- Shelby, NC
National Provider Identifier
1720595077
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- LAT-3590
- Practice address
- 127 Ramsgate Dr
Shelby, NC 28152-8509 - Phone
- (704) 473-4788
- NPI assigned
- Jan 9, 2018
- 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 | LAT-3590 | NC | Primary |
Addresses
Primary practice location
127 Ramsgate Dr
Shelby, NC 28152-8509
Mailing address
127 Ramsgate Dr
Shelby, NC 28152-8509
Phone (704) 473-4788
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| LAT-3590 | Other | NC | NORTH CAROLINA BOARD OF ATHLETIC TRAINER EXAMINERS |
| 2000020597 | Other | BOARD OF CERTIFICATION FOR THE ATHLETIC TRAINER |
Other names 1
- Mr. Tripp Hastings
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 |
|---|---|---|---|
| LAT-3590 | NC | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1515456000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1517529600000",
"number": "1720595077",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "127 RAMSGATE DR",
"city": "SHELBY",
"state": "NC",
"postal_code": "281528509",
"telephone_number": "704-473-4788"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "127 RAMSGATE DR",
"city": "SHELBY",
"state": "NC",
"postal_code": "281528509",
"telephone_number": "704-473-4788"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HASTINGS",
"first_name": "CLYDE",
"middle_name": "DONALD",
"name_prefix": "Mr.",
"name_suffix": "III",
"credential": "LAT, ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-01-09",
"last_updated": "2018-02-02",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NC",
"license": "LAT-3590",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NORTH CAROLINA BOARD OF ATHLETIC TRAINER EXAMINERS",
"identifier": "LAT-3590",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOARD OF CERTIFICATION FOR THE ATHLETIC TRAINER",
"identifier": "2000020597",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"first_name": "TRIPP",
"last_name": "HASTINGS",
"prefix": "MR.",
"code": "5",
"type": "Other Name"
}
]
}Other providers in Shelby, NC
- Harris Enterprises of NC Inc, D/B/a Greene Haven Family Care (Greene Haven Family Care)
- Autumn Joy Harris
- Richard Dean Harrison, LPC
- Harvestworks Inc.
- Carla Ann Hastings, LCSW-A
- Michael D. Hawkins, LMFT-A
- Marcie H Hayek, LPT
- Christina Duffy Hayes, PAC
- Patrick Robert-Lawrence Hayes, MD
- Healing Hearts Therapy Services
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.