Active NPI
Robert Grant
- Athletic Trainer
- Elk Grove Village, IL
National Provider Identifier
1922506542
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096.004363
- Practice address
- 990 Elk Grove Town Ctr
Elk Grove Village, IL 60007-3754 - Phone
- (847) 290-1111
- NPI assigned
- Jan 29, 2018
- Last updated
- Jan 29, 2018
- 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 | 096.004363 | IL | Primary |
Addresses
Primary practice location
990 Elk Grove Town Ctr
Elk Grove Village, IL 60007-3754
Mailing address
352 Marion Ave
Glen Ellyn, IL 60137-4014
Phone (608) 434-0081
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 |
|---|---|---|---|
| 096.004363 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1517184000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1517184000000",
"number": "1922506542",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "352 MARION AVE",
"city": "GLEN ELLYN",
"state": "IL",
"postal_code": "601374014",
"telephone_number": "608-434-0081"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "990 ELK GROVE TOWN CTR",
"city": "ELK GROVE VILLAGE",
"state": "IL",
"postal_code": "600073754",
"telephone_number": "847-290-1111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GRANT",
"first_name": "ROBERT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2018-01-29",
"last_updated": "2018-01-29",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096.004363",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elk Grove Village, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.