Active NPI
Jay Roberts, ATC
- Athletic Trainer
- Jackson, TN
National Provider Identifier
1891184792
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 620 Skyline Dr
Jackson, TN 38301-3923 - Phone
- (731) 541-5000
- Fax
- (731) 541-6251
- NPI assigned
- Jan 15, 2015
- 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 | TN | Primary |
Addresses
Primary practice location
620 Skyline Dr
Jackson, TN 38301-3923
Mailing address
620 Skyline Dr
Jackson, TN 38301-3923
Phone (731) 541-5000
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 996904 | Other | TN | ATHLETIC TRAINER CERTIFIED |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1421280000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1421280000000",
"number": "1891184792",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "620 SKYLINE DR",
"city": "JACKSON",
"state": "TN",
"postal_code": "383013923",
"telephone_number": "731-541-5000",
"fax_number": "731-541-6251"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "620 SKYLINE DR",
"city": "JACKSON",
"state": "TN",
"postal_code": "383013923",
"telephone_number": "731-541-5000",
"fax_number": "731-541-6251"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "JAY",
"credential": "ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2015-01-15",
"last_updated": "2015-01-15",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "TN",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ATHLETIC TRAINER CERTIFIED",
"identifier": "996904",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jackson, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.