Active NPI
Robert Michael Super, LAT, COF
- Athletic Trainer
- Plano, TX
National Provider Identifier
1982838496
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Athletic Trainer
- License
- RT005787
- Practice address
- 1255 W 15TH St Ste 540
Plano, TX 75075-7248 - Phone
- (410) 845-3929
- Fax
- (972) 767-3728
- NPI assigned
- May 12, 2009
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Orthotic Fitter | 225000000X | OF000004 | PA | |
| Athletic Trainer | 2255A2300X | RT005787 | PA | Primary |
Addresses
Primary practice location
1255 W 15TH St Ste 540
Plano, TX 75075-7248
Mailing address
5571 Easton Rd.
Pipersville, PA 18947
Phone (410) 845-3929
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 |
|---|---|---|---|
| OF000004 | PA | MD | Orthotic Fitter |
| RT005787 | PA | MD | Athletic Trainer |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242086400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1398556800000",
"number": "1982838496",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5571 EASTON RD.",
"city": "PIPERSVILLE",
"state": "PA",
"postal_code": "18947",
"telephone_number": "410-845-3929"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1255 W 15TH ST STE 540",
"city": "PLANO",
"state": "TX",
"postal_code": "750757248",
"telephone_number": "410-845-3929",
"fax_number": "972-767-3728"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUPER",
"first_name": "ROBERT",
"middle_name": "MICHAEL",
"credential": "LAT, COF",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-05-12",
"last_updated": "2014-04-27",
"status": "A"
},
"taxonomies": [
{
"code": "225000000X",
"taxonomy_group": "",
"desc": "Orthotic Fitter",
"state": "PA",
"license": "OF000004",
"primary": false
},
{
"code": "2255A2300X",
"taxonomy_group": "",
"desc": "Specialist/Technologist, Athletic Trainer",
"state": "PA",
"license": "RT005787",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plano, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.