Active NPI
Derek Alan Hornaman, ATC
- Athletic Trainer
- Erie, PA
National Provider Identifier
1932600582
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- RT004489
- Practice address
- 100 Peach St
Erie, PA 16507-1423 - Phone
- (814) 860-4706
- NPI assigned
- Feb 27, 2018
- 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 | RT004489 | PA | Primary |
Addresses
Primary practice location
100 Peach St
Erie, PA 16507-1423
Mailing address
4725 Conrad Rd
Erie, PA 16510-3815
Phone (814) 282-6817
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 |
|---|---|---|---|
| RT004489 | PA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1519689600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1519689600000",
"number": "1932600582",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4725 CONRAD RD",
"city": "ERIE",
"state": "PA",
"postal_code": "165103815",
"telephone_number": "814-282-6817"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 PEACH ST",
"city": "ERIE",
"state": "PA",
"postal_code": "165071423",
"telephone_number": "814-860-4706"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HORNAMAN",
"first_name": "DEREK",
"middle_name": "ALAN",
"credential": "ATC",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-02-27",
"last_updated": "2018-02-27",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "PA",
"license": "RT004489",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Erie, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 27, 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.