Active NPI
Ryan Casey Williamson, ATC
- Athletic Trainer
- Decatur, IL
National Provider Identifier
1881901593
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096.002425
- Practice address
- 304 W Hay St
Suite 218
Decatur, IL 62526-6328 - Phone
- (217) 877-2088
- Fax
- (217) 877-3622
- NPI assigned
- Sep 2, 2010
- 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 | 096.002425 | IL | Primary |
Addresses
Primary practice location
304 W Hay St
Suite 218
Decatur, IL 62526-6328
Mailing address
304 W Hay St
Suite 218
Decatur, IL 62526-6328
Phone (217) 877-2088
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1902989379 | Other | IL | NPI |
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 |
|---|---|---|---|
| 096.002425 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1283385600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1283385600000",
"number": "1881901593",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "304 W HAY ST",
"address_2": "SUITE 218",
"city": "DECATUR",
"state": "IL",
"postal_code": "625266328",
"telephone_number": "217-877-2088",
"fax_number": "217-877-3622"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "304 W HAY ST",
"address_2": "SUITE 218",
"city": "DECATUR",
"state": "IL",
"postal_code": "625266328",
"telephone_number": "217-877-2088",
"fax_number": "217-877-3622"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLIAMSON",
"first_name": "RYAN",
"middle_name": "CASEY",
"name_prefix": "Mr.",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-09-02",
"last_updated": "2010-09-02",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096.002425",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI",
"identifier": "1902989379",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Decatur, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.