Active NPI
Mark Donald Ulbricht, LAT, ATC
- Athletic Trainer
- Ashland, OR
National Provider Identifier
1972200681
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- AT-AT-10211957
- Practice address
- 1250 Siskiyou Blvd
Ashland, OR 97520-5001 - Phone
- (541) 552-6550
- NPI assigned
- Feb 13, 2023
- 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 | AT-AT-10211957 | OR | Primary |
Addresses
Primary practice location
1250 Siskiyou Blvd
Ashland, OR 97520-5001
Mailing address
2630 W Main St Unit 11
Medford, OR 97501-3697
Phone (503) 739-0550
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 |
|---|---|---|---|
| AT-AT-10211957 | OR | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1676246400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676246400000",
"number": "1972200681",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2630 W MAIN ST UNIT 11",
"city": "MEDFORD",
"state": "OR",
"postal_code": "975013697",
"telephone_number": "503-739-0550"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1250 SISKIYOU BLVD",
"city": "ASHLAND",
"state": "OR",
"postal_code": "975205001",
"telephone_number": "541-552-6550"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ULBRICHT",
"first_name": "MARK",
"middle_name": "DONALD",
"credential": "LAT, ATC",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2023-02-13",
"last_updated": "2023-02-13",
"certification_date": "2023-02-13",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "OR",
"license": "AT-AT-10211957",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ashland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 13, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.