Active NPI
Robert Charles Harrison, ATC
- Athletic Trainer
- Wildomar, CA
National Provider Identifier
1720744865
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 21800 Canyon Dr
Wildomar, CA 92595-9181 - Phone
- (951) 253-7200
- NPI assigned
- Nov 12, 2021
- 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
21800 Canyon Dr
Wildomar, CA 92595-9181
Mailing address
27031 N Bay LN
Menifee, CA 92585-5602
Phone (909) 261-4219
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2255A2300X | Medicaid | CA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | https://login.tigerconnect.com/app/messenger/ |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1636675200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636675200000",
"number": "1720744865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "27031 N BAY LN",
"city": "MENIFEE",
"state": "CA",
"postal_code": "925855602",
"telephone_number": "909-261-4219"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "21800 CANYON DR",
"city": "WILDOMAR",
"state": "CA",
"postal_code": "925959181",
"telephone_number": "951-253-7200"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HARRISON",
"first_name": "ROBERT",
"middle_name": "CHARLES",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-11-12",
"last_updated": "2021-11-12",
"certification_date": "2021-11-12",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2255A2300X",
"state": "CA"
}
],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "https://login.tigerconnect.com/app/messenger/",
"affiliation": "N",
"address_1": "27031 N Bay Ln",
"city": "Menifee",
"state": "CA",
"country_code": "US",
"postal_code": "925855602",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Wildomar, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.