Active NPI
Noah Reisig
- Athletic Trainer
- Brevard, NC
National Provider Identifier
1720747967
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- LAT-5048
- Practice address
- 1 Brevard College Dr
Brevard, NC 28712-4283 - Phone
- (828) 641-0246
- NPI assigned
- Dec 15, 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 | LAT-5048 | NC | Primary |
Addresses
Primary practice location
1 Brevard College Dr
Brevard, NC 28712-4283
Mailing address
1 Brevard College Dr
Brevard, NC 28712-4283
Phone (828) 641-0246
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | N/A |
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-5048 | NC | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1639526400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1639526400000",
"number": "1720747967",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1 BREVARD COLLEGE DR",
"city": "BREVARD",
"state": "NC",
"postal_code": "287124283",
"telephone_number": "828-641-0246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 BREVARD COLLEGE DR",
"city": "BREVARD",
"state": "NC",
"postal_code": "287124283",
"telephone_number": "828-641-0246"
}
],
"practiceLocations": [],
"basic": {
"last_name": "REISIG",
"first_name": "NOAH",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-12-15",
"last_updated": "2021-12-15",
"certification_date": "2021-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "NC",
"license": "LAT-5048",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "N/A",
"affiliation": "N",
"address_1": "1 Brevard College Dr",
"city": "Brevard",
"state": "NC",
"country_code": "US",
"postal_code": "287124283",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Brevard, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 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.