Active NPI
Phillip Brent Rossberg, ATC, LAT
- Athletic Trainer
- Tinley Park, IL
National Provider Identifier
1942587688
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096.003152
- Practice address
- 8407 Castle Dr
Tinley Park, IL 60487-7645 - Phone
- (708) 334-5039
- NPI assigned
- Nov 9, 2011
- 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 | 096.003152 | IL | Primary |
Addresses
Primary practice location
8407 Castle Dr
Tinley Park, IL 60487-7645
Mailing address
8407 Castle Dr
Tinley Park, IL 60487-7645
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 |
|---|---|---|---|
| 096.003152 | IL | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1320796800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1320796800000",
"number": "1942587688",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8407 CASTLE DR",
"city": "TINLEY PARK",
"state": "IL",
"postal_code": "604877645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8407 CASTLE DR",
"city": "TINLEY PARK",
"state": "IL",
"postal_code": "604877645",
"telephone_number": "708-334-5039"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSSBERG",
"first_name": "PHILLIP",
"middle_name": "BRENT",
"credential": "ATC, LAT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-11-09",
"last_updated": "2011-11-09",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096.003152",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tinley Park, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.