NICHOLAS ANTONELLI, ATC — NPI 1780044776 (Licensed & Credentialed Specialist/Technologist, Athletic Trainer in FORT BRAGG, NC)

CMS-1500 Box 24J / 33a • NPI

1780044776

Type 1 Individual Rendering/Ordering

HIPAA NUCC Taxonomy • CMS Code

2255A2300X

Licensed & Credentialed Specialist/Technologist, Athletic Trainer

Box 32 Service Location & ZIP+4

2817 REILLY RD, WAMC CREDENTIALING, FORT BRAGG, NC, 28310

Official NPPES Practice Location

Practice Phone & Referral Fax

(517) 896-0261

Direct NPPES Verification Line

✓ HHS OIG LEIE Sanction Screening — VERIFIED CLEAR: NPI 1780044776 (NICHOLAS ANTONELLI, ATC) has 0 active federal exclusions across all 84,224 HHS OIG LEIE sanction records (Database Verified: 2026-11-11).

CMS Medicare Order & Referring PECOS Eligibility

This practitioner does not currently appear in the CMS individual Order & Referring PECOS file (may practice in pediatrics, commercial-only networks, or hospital-employed settings).

Official CMS NPPES Credential & Practice Profile

10-Digit NPI Number	`1780044776` (NPI-1 Individual Practitioner)
Provider / Legal Name	NICHOLAS ANTONELLI, ATC
Plain-English Specialty	Licensed & Credentialed Specialist/Technologist, Athletic Trainer NUCC Code: `2255A2300X` (Specialist/Technologist, Athletic Trainer)
Certifying / Licensing Body	State Medical / Healthcare Licensing Board & National Specialty Board
Practice Location Address	2817 REILLY RD, WAMC CREDENTIALING, FORT BRAGG, NC, 28310
Practice Telephone / Fax	Tel: (517) 896-0261
Administrative Mailing Address	2817 REILLY ST, FORT BRAGG, NC, 28310-7324
Enumeration & Last Sync	Enumerated: 2016-03-03 \| CMS Record Updated: 2022-07-29

Clinic Location, Accessibility & Directions

📍 Practice Location & Patient Access

2817 REILLY RD, WAMC CREDENTIALING, FORT BRAGG, NC, 28310

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Plain-English Taxonomy & CMS Crosswalk (2255A2300X)

What Does Taxonomy Code 2255A2300X Mean?

In the HIPAA National Uniform Claim Committee (NUCC) classification, code 2255A2300X translates to:
"Licensed & Credentialed Specialist/Technologist, Athletic Trainer"

CMS-1500 Medicare Specialty Crosswalk: Standard HIPAA X12N 837P / CMS-1500
Certifying / Accrediting Authority: State Medical / Healthcare Licensing Board & National Specialty Board
Clinical Scope: Consult a verified Specialist/Technologist, Athletic Trainer for specialized diagnostic evaluation, treatment planning, and continuity of care.

Specialty Clinical Procedures & Therapeutic Classes

Standard Scope of Care (NICHOLAS ANTONELLI, ATC)

Typical CPT / Diagnostic Procedures:

Comprehensive Outpatient & Inpatient Clinical Evaluation (CPT 99202–99215)
Diagnostic Workup, Laboratory Ordering & Evidence-Based Care Coordination
Preventive Screening, Patient Counseling & Multidisciplinary Referral

Common Therapeutic Classes:

Evidence-Based Specialty Pharmacotherapy & Preventive Regimens (CMS Part D Standard)

All Registered NUCC Taxonomies & State Licenses

Taxonomy Code & Plain-English Description	State License & Primary Status
`2255A2300X` — Specialist/Technologist, Athletic Trainer Plain English: Licensed & Credentialed Specialist/Technologist, Athletic Trainer	State: IN \| License: `36002358A` \| Primary: Yes (Primary)

Medical Billing, RCM & Hospital Credentialing Teams:

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NICHOLAS ANTONELLI, ATC (NPI #1780044776)