Active NPI
Sean Faulkner
- Athletic Trainer
- Rock Island, IL
National Provider Identifier
1972365716
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- 096004587
- Practice address
- 639 38TH St
Rock Island, IL 61201-2296 - Phone
- (309) 794-8793
- Fax
- (309) 794-8709
- NPI assigned
- Jan 26, 2024
- 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 | 096004587 | IL | Primary |
Addresses
Primary practice location
639 38TH St
Rock Island, IL 61201-2296
Mailing address
639 38TH St
Rock Island, IL 61201-2210
Phone (309) 794-8793
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 |
|---|---|---|---|
| 096004587 | IL | MD | Athletic Trainer |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Augustana College | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Audiologist-Hearing Aid Fitter
- Rock Island, IL
- NPI 1831433416
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1706227200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1706227200000",
"number": "1972365716",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "639 38TH ST",
"city": "ROCK ISLAND",
"state": "IL",
"postal_code": "612012210",
"telephone_number": "309-794-8793",
"fax_number": "309-794-8709"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "639 38TH ST",
"city": "ROCK ISLAND",
"state": "IL",
"postal_code": "612012296",
"telephone_number": "309-794-8793",
"fax_number": "309-794-8709"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FAULKNER",
"first_name": "SEAN",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2024-01-26",
"last_updated": "2024-01-26",
"certification_date": "2024-01-24",
"status": "A"
},
"taxonomies": [
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "IL",
"license": "096004587",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rock Island, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.