Active NPI
Jordan Ellis
- Athletic Trainer
- Omaha, NE
National Provider Identifier
1891239901
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- Practice address
- 5814 S 105TH St
Omaha, NE 68127-2909 - Phone
- (402) 321-6867
- NPI assigned
- Dec 8, 2016
- 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 | Primary |
Addresses
Primary practice location
5814 S 105TH St
Omaha, NE 68127-2909
Mailing address
5814 S 105TH St
Omaha, NE 68127-2909
Phone (402) 321-6867
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": "1481155200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1481155200000",
"number": "1891239901",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5814 S 105TH ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681272909",
"telephone_number": "402-321-6867"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5814 S 105TH ST",
"city": "OMAHA",
"state": "NE",
"postal_code": "681272909",
"telephone_number": "402-321-6867"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ELLIS",
"first_name": "JORDAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-12-08",
"last_updated": "2016-12-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Omaha, NE
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.