Jackson Ryan Brunner, LAT, ATC
NPI 1821563453ActiveIndividual· Specialist/Technologist, Athletic Trainer· Normal, IL
Specialist/Technologist, Athletic Trainer (LAT, ATC) in Normal, Illinois, licensed in IL, with an NPI issued in October 2018.
Overview
| NPI | 1821563453 |
|---|---|
| Status | Active |
| Entity type | Individual |
| Credential | LAT, ATC |
| Sole proprietor | No |
| NPI issued | Oct 10, 2018 |
| Last updated in NPPES | Sep 28, 2021 |
| Certified by provider | Sep 28, 2021 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Specialist/Technologist, Athletic Trainer Primary | 2255A2300X | 096.004944 | IL |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Nov 10, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 11, 2026 | No match | — |
| New York OMIG · Nov 11, 2026 | No match | — |
| Ohio Medicaid · Nov 11, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 11, 2026 | No match | — |
| Washington HCA · Nov 11, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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