Samuel Lee Niedergerke

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

24-01823 Issued in KS

Practice address

741S Ray Rd
Fort Riley, KS 66442

Phone

(573) 230-7959

NPI assigned

Nov 2, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1509580800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1767052800000",
    "number": "1932611779",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "909 WAXWING DR",
            "city": "MANHATTAN",
            "state": "KS",
            "postal_code": "665026747",
            "telephone_number": "573-230-7959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "741S RAY RD",
            "city": "FORT RILEY",
            "state": "KS",
            "postal_code": "66442",
            "telephone_number": "573-230-7959"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "411 Central Methodist Sq",
            "address_purpose": "LOCATION",
            "city": "Fayette",
            "state": "MO",
            "postal_code": "652481104",
            "country_code": "US",
            "telephone_number": "660-248-3391",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "NIEDERGERKE",
        "first_name": "SAMUEL",
        "middle_name": "LEE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-11-02",
        "last_updated": "2025-12-30",
        "certification_date": "2025-12-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096005167",
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "KS",
            "license": "24-01823",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• National Vision, Inc.
• Linda Sue Nazeck, LSCSW
• Jonathan Neese
• Aileene Mauricio Nejal, PTA
• Amanda Nelson, PHARMD
• Rossmichael Noffsinger, LCSW
• Nancy Noyes
• Maria D Nunez
• Nathan Wayne Nutter
• Kathleen Marie O'Brien, MD

• Athletic Trainer in Fort Riley, KS
• Providers in Fort Riley, KS by specialty
• Athletic Trainer in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.