Active NPI
Jake Rathsack
- Athletic Trainer
- Oshkosh, WI
National Provider Identifier
1952812372
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 2055
- Practice address
- 712 Elmwood Ave
Oshkosh, WI 54901-3517 - Phone
- (920) 629-8583
- NPI assigned
- Oct 12, 2017
- 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 | 2055 | WI | Primary |
Addresses
Primary practice location
712 Elmwood Ave
Oshkosh, WI 54901-3517
Mailing address
3321 Kimberly Cir
Manitowoc, WI 54220-1297
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507766400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1593129600000",
"number": "1952812372",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3321 KIMBERLY CIR",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542201297"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "712 ELMWOOD AVE",
"city": "OSHKOSH",
"state": "WI",
"postal_code": "549013517",
"telephone_number": "920-629-8583"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RATHSACK",
"first_name": "JAKE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2017-10-12",
"last_updated": "2020-06-26",
"certification_date": "2020-06-26",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "WI",
"license": "2055",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oshkosh, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 26, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.