Active NPI
Bryce Thomas Goodall
- Athletic Trainer
- Machesney Park, IL
National Provider Identifier
1750879300
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 725 Colonial Dr
Machesney Park, IL 61115-3715 - Phone
- (815) 520-9260
- NPI assigned
- Apr 30, 2018
- 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
725 Colonial Dr
Machesney Park, IL 61115-3715
Mailing address
725 Colonial Dr
Machesney Park, IL 61115-3715
Phone (815) 520-9260
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": "1525046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525046400000",
"number": "1750879300",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "725 COLONIAL DR",
"city": "MACHESNEY PARK",
"state": "IL",
"postal_code": "611153715",
"telephone_number": "815-520-9260"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "725 COLONIAL DR",
"city": "MACHESNEY PARK",
"state": "IL",
"postal_code": "611153715",
"telephone_number": "815-520-9260"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODALL",
"first_name": "BRYCE",
"middle_name": "THOMAS",
"name_prefix": "Mr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-04-30",
"last_updated": "2018-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Machesney Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 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.