Active NPI
Russell Boardman
- Athletic Trainer
- Fall River, MA
National Provider Identifier
1932238433
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 910
- Practice address
- 363 Highland Ave
Fall River, MA 02720-3703 - Phone
- (508) 679-3131
- NPI assigned
- Mar 2, 2007
- 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 | 910 | MA | Primary |
Addresses
Primary practice location
363 Highland Ave
Fall River, MA 02720-3703
Mailing address
1003 Meridian St
Fall River, MA 02720-4679
Phone (508) 679-3131
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 |
|---|---|---|---|
| 910 | MA | MD | Renal Nutrition Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172793600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1932238433",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1003 MERIDIAN ST",
"city": "FALL RIVER",
"state": "MA",
"postal_code": "027204679",
"telephone_number": "508-679-3131"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "363 HIGHLAND AVE",
"city": "FALL RIVER",
"state": "MA",
"postal_code": "027203703",
"telephone_number": "508-679-3131"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOARDMAN",
"first_name": "RUSSELL",
"name_prefix": "Mr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "MA",
"license": "910",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fall River, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.