Individual provider Active NPI

David R Knieriem, MD

  • Family Medicine Physician
  • Rossford, OH
National Provider Identifier
1083858906
Registry record updated Nov 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35.098188 Issued in OH
Practice address
1215 Grassy LN
Rossford, OH 43460-1525
Phone
(419) 661-9730
Fax
(419) 661-9730
NPI assigned
Apr 22, 2009
Last updated
Nov 3, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 3, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35.098188 OH Primary

Addresses

Primary practice location

1215 Grassy LN
Rossford, OH 43460-1525

Mailing address

1215 Grassy LN
Rossford, OH 43460-1525
Phone (419) 661-9730

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address dknieriem26410@epicdirect.promedica.org

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120809000719 OH Practitioner - Family Practice 5092961862 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
35.098188OHMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Promedica Central Physicians CurrentSince Dec 31, 2015 Accepting new patients
Promedica Central Physicians Family Medicine CurrentSince Dec 31, 2015 Accepting new patients

Locations

3156 Dustin Rd
Ste 203
Oregon, OH 43616
Phone (419) 698-1514

1215 Grassy Ln
Rossford, OH 43460
Phone (419) 661-9727

100 Madison Ave
Toledo, OH 43604
Phone (567) 585-1964

1 Seagate
#800
Toledo, OH 43604
Phone (567) 585-1964

2109 Hughes Dr
Ste 450
Toledo, OH 43606
Phone (419) 251-3112

Interoperability endpoints

  • Direct secure messaging: dknieriem26410@direct.promedica.org

Organizations & group practices 2

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1240358400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698969600000",
    "number": "1083858906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1215 GRASSY LN",
            "city": "ROSSFORD",
            "state": "OH",
            "postal_code": "434601525",
            "telephone_number": "419-661-9730",
            "fax_number": "419-661-9730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 GRASSY LN",
            "city": "ROSSFORD",
            "state": "OH",
            "postal_code": "434601525",
            "telephone_number": "419-661-9730",
            "fax_number": "419-661-9730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNIERIEM",
        "first_name": "DAVID",
        "middle_name": "R",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-04-22",
        "last_updated": "2023-11-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35.098188",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dknieriem26410@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "100 Madison Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436041516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rossford, OH

Sources for this page

Verify at the official NPI Registry.