Kyle A Knoell – Sports Physician Chiropractor

Key facts

NPI: 1003018680
Entity type: Individual (NPI type 1)
Primary specialty: Sports Physician Chiropractor 111NS0005X
License: 38MC00521600 (NJ)
Practice address: 540 Bordentown Ave
4 FL, Suite 4900
South Amboy, NJ 08879
Phone: (732) 721-3300
Fax: (732) 721-3302
NPI assigned: Jun 5, 2007
Sex: Male
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

CMP Group,PC Sports Physician Chiropractor · South Amboy, NJ · NPI 1033661236

Medicare reassignment Authorized official NJ

Medicare Care Compare profile

Specialty: Chiropractic
Education: New York Chiropractic College, 1995
Medicare assignment: Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

540 Bordentown Ave
South Amboy, NJ 08879-1546
Phone (732) 721-3300

Medicare participation

Medicare fee-for-service enrollment: Enrolled in NJ

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20060215000579	NJ	Practitioner - Chiropractic	5092739227	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes

State licenses

License	State	Type	Specialty
38MC00521600	NY	MD	Rehabilitation Chiropractor
38MC00521600	NJ	MD	Sports Physician Chiropractor
38MC00521600	TX	MD	Sports Physician Chiropractor

Interoperability endpoints

FHIR API: https://fhir4.healow.com/fhir/r4/IHJHBD

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Sports Physician Chiropractor	111NS0005X	38MC00521600	NJ	Yes
Sports Physician Chiropractor	111NS0005X	38MC00521600	TX
Rehabilitation Chiropractor	111NR0400X	38MC00521600	NY
Independent Medical Examiner Chiropractor	111NI0013X	38MC00521600	TX

Addresses

Primary practice location

540 Bordentown Ave
4 FL, Suite 4900
South Amboy, NJ 08879

Mailing address

PO Box 61
East Brunswick, NJ 08816-0061
Phone (732) 721-3300

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Dec 21, 2016.

{
    "created_epoch": "1181001600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1482278400000",
    "number": "1003018680",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 61",
            "city": "EAST BRUNSWICK",
            "state": "NJ",
            "postal_code": "088160061",
            "telephone_number": "732-721-3300",
            "fax_number": "732-721-3302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "540 BORDENTOWN AVE",
            "address_2": "4 FL, SUITE 4900",
            "city": "SOUTH AMBOY",
            "state": "NJ",
            "postal_code": "08879",
            "telephone_number": "732-721-3300",
            "fax_number": "732-721-3302"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNOELL",
        "first_name": "KYLE",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DC, MHA, CCCSMP, CCI",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-06-05",
        "last_updated": "2016-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "NJ",
            "license": "38MC00521600",
            "primary": true
        },
        {
            "code": "111NS0005X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Sports Physician",
            "state": "TX",
            "license": "38MC00521600",
            "primary": false
        },
        {
            "code": "111NR0400X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Rehabilitation",
            "state": "NY",
            "license": "38MC00521600",
            "primary": false
        },
        {
            "code": "111NI0013X",
            "taxonomy_group": "",
            "desc": "Chiropractor, Independent Medical Examiner",
            "state": "TX",
            "license": "38MC00521600",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in South Amboy, NJ

All providers in South Amboy, NJ · Sports Physician Chiropractor in New Jersey

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 21, 2016. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.