Active NPI
Sheldon Skyler Burgess, ATC, LAT, CSMS-1
- Athletic Trainer
- Boise, ID
National Provider Identifier
1811545684
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT-696
- Practice address
- 6165 W Emerald St
Boise, ID 83704-8613 - Phone
- (208) 302-3500
- NPI assigned
- Aug 26, 2019
- 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 | AT-696 | ID | Primary |
Addresses
Primary practice location
6165 W Emerald St
Boise, ID 83704-8613
Mailing address
6325 S Rockrose Way
Boise, ID 83716-7133
Phone (208) 761-5396
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 |
|---|---|---|---|
| AT-696 | ID | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1566777600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1566777600000",
"number": "1811545684",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6325 S ROCKROSE WAY",
"city": "BOISE",
"state": "ID",
"postal_code": "837167133",
"telephone_number": "208-761-5396"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6165 W EMERALD ST",
"city": "BOISE",
"state": "ID",
"postal_code": "837048613",
"telephone_number": "208-302-3500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BURGESS",
"first_name": "SHELDON",
"middle_name": "SKYLER",
"credential": "ATC, LAT, CSMS-1",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-08-26",
"last_updated": "2019-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "ID",
"license": "AT-696",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.