JACOB RILEY PROFFER (NPI# 1811404171) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1811404171 |
| Entity Type | Individual |
| Full Name | JACOB RILEY PROFFER |
| Practice Address |
1001 E 17th St Bloomington IN 47408-1590 |
| Mailing Address |
5846 Timber Lake Way Indianapolis IN 46237-2277 |
| Practice Telephone | 3173402320 |
| Mailing Telephone | 3173402320 |
| Enumeration Date | 2018-01-08 |
| Last Update Date | 2018-03-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2255A2300X |
Specialist/Technologist Specialization: Athletic Trainer |
Respiratory, Developmental, Rehabilitative and Restorative Service Providers | ||
| Y | 390200000X | Student in an Organized Health Care Education/Training Program | Student, Health Care |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 5846 Timber Lake Way, Indianapolis, IN 462372277 | 3173402320 |
| Street Address |
1001 E 17TH ST |
| City | BLOOMINGTON |
| State | IN |
| Zip Code | 47408-1590 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1659376424 | Andy S. Hipskind | Family Medicine | 1001 E 17th St, Bloomington, IN 47408-1590 | 2005-06-16 |
| 1831757541 | Hannah Nicole Miller | Specialist/Technologist | 1001 E 17th St, Bloomington, IN 47408-1590 | 2019-05-29 |
| 1528525920 | Jacob Steven Laverman | Physical Therapist | 1001 E 17th St, Bloomington, IN 47408-1590 | 2019-02-22 |
| 1730671934 | Lewis Meyer Young | Neuromusculoskeletal Medicine, Sports Medicine | 1001 E 17th St, Bloomington, IN 47408-1590 | 2018-06-04 |
| 1376057083 | Katherine Adair O'donnell | Specialist/Technologist | 1001 E 17th St, Bloomington, IN 47408-1590 | 2017-11-17 |
| 1003341918 | Jonathan Wicks | Psychiatry & Neurology | 1001 E 17th St, Bloomington, IN 47408-1590 | 2017-04-28 |
| 1396277240 | Athletico, Ltd. | Physical Therapist | 1001 E 17th St, Bloomington, IN 47408-1590 | 2017-03-30 |
| 1003354242 | Mitch Taffe | Specialist/Technologist | 1001 E 17th St, Athletic Training, Bloomington, IN 47408-1590 | 2017-02-08 |
| 1992170898 | John Pauer | Specialist/Technologist | 1001 E 17th St, Bloomington, IN 47408-1590 | 2015-12-03 |
| 1790158954 | Kelly Whitney-babcock | Specialist/Technologist | 1001 E 17th St, Bloomington, IN 47408-1590 | 2015-11-09 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1669079398 | Ta-kisha Jones | Health Educator | 309 N. Woodlawn Ave, Bloomington, IN 47408 | 2020-10-06 |
| 1265915904 | Meghan Elizabeth Kinkead | Specialist/Technologist | Simon Skjodt Assembly Hall, 1001 East 17th Street, Bloomington, IN 47408 | 2018-09-10 |
| 1316499395 | Marabai Rose Counseling, LLC | Social Worker | 4568 East State Rd 45, Bloomington, IN 47408 | 2016-10-26 |
| 1295133908 | Eden Embree | Specialist/Technologist | 1001 E. 17th Street, Assembly Hall, Bloomington, IN 47408 | 2014-12-11 |
| 1588995229 | Create-a-smile PC | Dentist | 219 E. 17th St., Bloomington, IN 47408 | 2010-01-20 |
| 1609053289 | Laurette Frazier | Counselor | 2815 E. 10th Street, Stone Belt, Bloomington, IN 47408 | 2008-01-26 |
| 1770709917 | Robin A. Roberts | Dentist | 104 E. 19th Street, Bloomington, IN 47408 | 2007-04-17 |
| 1376614008 | David Rudolf Fletcher | General Practice | 126 S. Hampton Ct, Bloomington, IN 47408 | 2006-11-13 |
| 1114013752 | Christole, Inc | Intermediate Care Facility, Mentally Retarded | 2727 N Dunn, Bloomington, IN 47408 | 2006-10-04 |
| 1003850322 | Priti V Jindal | Internal Medicine | 2455 N Tamarack Trl, Bloomington, IN 47408 | 2006-06-16 |
| Find all providers in zip 47408 | ||||
| Taxonomy Code | 390200000X |
| Grouping | Student, Health Care |
| Classification | Student in an Organized Health Care Education/Training Program |
| An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |
| Notes: [1/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275132003 | Faizo A Hersi | Student in an Organized Health Care Education/Training Program | 9700 International Dr Suite 300, Bloomington, MN 55425 | 2020-10-22 |
| 1528689312 | Cody Schroeder | Student in an Organized Health Care Education/Training Program | 19 Norman Ridge Dr, Bloomington, MN 55437-1749 | 2020-05-03 |
| 1578117107 | Ingrid Alexis Lopez | Student in an Organized Health Care Education/Training Program | 9817 Vine St, Bloomington, CA 92316-2038 | 2019-07-31 |
| 1356907026 | Shannon G Freed | Student in an Organized Health Care Education/Training Program | 10660 Hampshire Ave S Apt 3102, Bloomington, MN 55438-2629 | 2019-05-17 |
| 1730649062 | Matthew Acton | Student in an Organized Health Care Education/Training Program | 2341 E Plateau Pl, Bloomington, IN 47401-9502 | 2019-03-22 |
| 1881158012 | Amber Caitlyn Bentley | Student in an Organized Health Care Education/Training Program | 701 N Walnut St Apt 211, Bloomington, IN 47404-4038 | 2019-01-22 |
| 1104337245 | Ashley Roy | Student in an Organized Health Care Education/Training Program | 1202 N Walnut St, Bloomington, IN 47404-3534 | 2017-10-16 |
| 1326584244 | Jonah Harrison Prickel | Student in an Organized Health Care Education/Training Program | 713 S Brighton Crst, Bloomington, IN 47401-8684 | 2017-01-17 |
| 1215327630 | Miranda Lofgren | Student in an Organized Health Care Education/Training Program | 2036 N Walnut St, Apt B17, Bloomington, IN 47404-2465 | 2015-01-24 |
| 1598154825 | Tyler Daniel Reems | Student in an Organized Health Care Education/Training Program | 935 S Copper Beech Way Apt E, Bloomington, IN 47403-5242 | 2015-01-09 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 47408 |
Please comment or provide details below to improve the information on JACOB RILEY PROFFER.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.