Matthew Mark Fitterer, MS, ATC, CSCS

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

096.002025 Issued in IL

Practice address

2826 Iroquois Dr
Thompsons Station, TN 37179-5003

Phone

(217) 766-2343

NPI assigned

Jun 26, 2008

Last updated

Jun 11, 2019By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

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

{
    "created_epoch": "1214438400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1560211200000",
    "number": "1962664417",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1316 BLUEGRASS LN",
            "city": "CHAMPAIGN",
            "state": "IL",
            "postal_code": "618222094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2826 IROQUOIS DR",
            "city": "THOMPSONS STATION",
            "state": "TN",
            "postal_code": "371795003",
            "telephone_number": "217-766-2343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FITTERER",
        "first_name": "MATTHEW",
        "middle_name": "MARK",
        "name_prefix": "Mr.",
        "credential": "MS, ATC, CSCS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-06-26",
        "last_updated": "2019-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "IL",
            "license": "096.002025",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Athletic Trainer in Thompsons Station, TN
• Providers in Thompsons Station, TN by specialty
• Athletic Trainer in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2019; 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.