Active NPI
Alexander C Mellin, MS, ATC, LAT
- Athletic Trainer
- Lowell, MA
National Provider Identifier
1780224246
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2000023944
- Practice address
- Costello Athletic Center
275 Riverside Street
Lowell, MA 01854 - Phone
- (978) 934-2373
- NPI assigned
- Jan 13, 2020
- 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 | 2000023944 | Primary |
Addresses
Primary practice location
Costello Athletic Center
275 Riverside Street
Lowell, MA 01854
Mailing address
Costello Athletic Center
275 Riverside Street
Lowell, MA 01854
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2000023944 | Other | NATA BOARD OF CERTIFICATION, CERTIFIED ATHLETIC TRAINER | |
| 3249-AH-AT | Other | MA | COMMONWEALTH OF MASSACHUSETTS DIVISION OF PROFESSIONAL LICENSURE |
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
- Credentials
- Master of Science
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1578873600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1578873600000",
"number": "1780224246",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "COSTELLO ATHLETIC CENTER",
"address_2": "275 RIVERSIDE STREET",
"city": "LOWELL",
"state": "MA",
"postal_code": "01854"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "COSTELLO ATHLETIC CENTER",
"address_2": "275 RIVERSIDE STREET",
"city": "LOWELL",
"state": "MA",
"postal_code": "01854",
"telephone_number": "978-934-2373"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MELLIN",
"first_name": "ALEXANDER",
"middle_name": "C",
"credential": "MS, ATC, LAT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-01-13",
"last_updated": "2020-01-13",
"certification_date": "2020-01-13",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": "2000023944",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATA BOARD OF CERTIFICATION, CERTIFIED ATHLETIC TRAINER",
"identifier": "2000023944",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COMMONWEALTH OF MASSACHUSETTS DIVISION OF PROFESSIONAL LICENSURE",
"identifier": "3249-AH-AT",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Lowell, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.