Active NPI
Douglas A West, ATC
- Athletic Trainer
- Bloomington, IL
National Provider Identifier
1821396722
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096003032
- Practice address
- 1701 E College Ave
Bloomington, IL 61704-2101 - Phone
- (309) 664-3038
- Fax
- (309) 664-3119
- NPI assigned
- Mar 2, 2011
- Last updated
- Mar 2, 2011
- 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 | 096003032 | IL | Primary |
Addresses
Primary practice location
1701 E College Ave
Bloomington, IL 61704-2101
Mailing address
1205 N Livingston St
Bloomington, IL 61701-1534
Phone (309) 838-3640
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 |
|---|---|---|---|
| 096003032 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1299024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1299024000000",
"number": "1821396722",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1205 N LIVINGSTON ST",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617011534",
"telephone_number": "309-838-3640"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1701 E COLLEGE AVE",
"city": "BLOOMINGTON",
"state": "IL",
"postal_code": "617042101",
"telephone_number": "309-664-3038",
"fax_number": "309-664-3119"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WEST",
"first_name": "DOUGLAS",
"middle_name": "A",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-03-02",
"last_updated": "2011-03-02",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096003032",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bloomington, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.