Active NPI
Cody Ryan Wade, ATC
- Athletic Trainer
- Pearland, TX
National Provider Identifier
1740731785
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT4303
- Practice address
- 11850 Broadway St
Pearland, TX 77584-3972 - Phone
- (281) 299-2127
- NPI assigned
- Oct 14, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | 070802059 | TX | |
| Athletic Trainer | 2255A2300X | AT4303 | TX | Primary |
Addresses
Primary practice location
11850 Broadway St
Pearland, TX 77584-3972
Mailing address
330 Kendall Crest Dr
Alvin, TX 77511-5128
Phone (281) 299-2127
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22 | Other | TX | ATHLETIC TRAINER |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | cwade@alvinisd.net | Direct |
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 |
|---|---|---|---|
| AT4303 | TX | MD | Athletic Trainer |
| 070802059 | TX | MD | Student in an Organized Health Care Education/Training Program |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1609804800000",
"number": "1740731785",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "330 KENDALL CREST DR",
"city": "ALVIN",
"state": "TX",
"postal_code": "775115128",
"telephone_number": "281-299-2127"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11850 BROADWAY ST",
"city": "PEARLAND",
"state": "TX",
"postal_code": "775843972",
"telephone_number": "281-299-2127"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WADE",
"first_name": "CODY",
"middle_name": "RYAN",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-10-14",
"last_updated": "2021-01-05",
"certification_date": "2021-01-05",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "TX",
"license": "070802059",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TX",
"license": "AT4303",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ATHLETIC TRAINER",
"identifier": "22",
"state": "TX"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "cwade@alvinisd.net",
"affiliation": "N",
"endpointDescription": "Email",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "11850 Broadway St",
"city": "Pearland",
"state": "TX",
"country_code": "US",
"postal_code": "775843972",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Pearland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 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.