MEDICARE: RYAN MARGOLD MAT, LAT, ATC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2255A2300X	Athletic Trainer	096.005604	IL

General Provider Information

NPI Number	:	1780516955
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN MARGOLD MAT, LAT, ATC

Provider Business Mailing Address
First Line	:	4521 ASH GROVE DR APT B1
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62711-6538
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 UNIVERSITY PLZ
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62703-5404
Country	:	US
Telephone Number	:	217-836-5800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

Similar Medicare Providers

1467527317 — DR. MICHAEL B HALLE MD
Practice Location Address:

2101 E JEFFERSON ST , KAISER PERMANENTE SPRINGFIELD MEDICARE ENROLLMENT
ROCKVILLE, MD
20852-4908

Practice Phone: 701-922-1000
Practice Fax: 703-922-1039

1598697823 — LONNDON TAYLOR SHAFFER
Practice Location Address:

5220 6TH STREET FRONTAGE RD E STE 1700
SPRINGFIELD, IL
62703-5771

Practice Phone: 217-525-8332
Practice Fax:

1992637045 — DELANEE PEYTON MATHON
Practice Location Address:

5220 6TH STREET FRONTAGE RD E STE 1700
SPRINGFIELD, IL
62703-5771

Practice Phone: 217-525-8332
Practice Fax:

1770415630 — KRISTA MICHELLE BARRON BIVENS
Practice Location Address:

2200 S 6TH ST
SPRINGFIELD, IL
62703-3454

Practice Phone: 217-698-7150
Practice Fax: 217-698-7085

1902738750 — MYVERNE ARIEL ANDERSON
Practice Location Address:

5220 6TH STREET FRONTAGE RD E STE 1700
SPRINGFIELD, IL
62703-5771

Practice Phone: 217-525-8332
Practice Fax:

1720910573 — ISON DAVID SMITH
Practice Location Address:

5220 6TH STREET FRONTAGE RD E STE 1700
SPRINGFIELD, IL
62703-5771

Practice Phone: 217-525-8332
Practice Fax:

Directions to “ RYAN MARGOLD MAT, LAT, ATC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.