Active NPI
Noah Wagner
- Athletic Trainer
- Frisco, CO
National Provider Identifier
1821681925
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT.0002450
- Practice address
- 505 Copper Road
Frisco, CO 80443 - Phone
- (888) 350-1544
- NPI assigned
- Feb 19, 2021
- 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 | AT.0002450 | CO | Primary |
Addresses
Primary practice location
505 Copper Road
Frisco, CO 80443
Mailing address
305 Chadwyck LN
Lititz, PA 17543-7451
Phone (845) 476-9824
Other practice location 1
700 S High St
West Chester, PA 19383-0001
Phone (610) 436-1000
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2000051106 | Other | BOC | |
| AT.0002450 | Other | CO | COLORADO DEPARTMENT OF REGULATORY AGENCIES |
| 304994 | Other | PA | NATA |
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.0002450 | CO | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1613692800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654646400000",
"number": "1821681925",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "305 CHADWYCK LN",
"city": "LITITZ",
"state": "PA",
"postal_code": "175437451",
"telephone_number": "845-476-9824"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "505 COPPER ROAD",
"city": "FRISCO",
"state": "CO",
"postal_code": "80443",
"telephone_number": "888-350-1544"
}
],
"practiceLocations": [
{
"address_1": "700 S High St",
"address_purpose": "LOCATION",
"city": "West Chester",
"state": "PA",
"postal_code": "193830001",
"country_code": "US",
"telephone_number": "610-436-1000",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "WAGNER",
"first_name": "NOAH",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-02-19",
"last_updated": "2022-06-08",
"certification_date": "2022-06-01",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "CO",
"license": "AT.0002450",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BOC",
"identifier": "2000051106",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "COLORADO DEPARTMENT OF REGULATORY AGENCIES",
"identifier": "AT.0002450",
"state": "CO"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NATA",
"identifier": "304994",
"state": "PA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Frisco, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 8, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.