Individual provider Active NPI

Laura Rochelle Knoop, PA-C

  • Physician Assistant
  • Mason, OH
National Provider Identifier
1104046606
Registry record updated Apr 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
50.000837 Issued in OH
Practice address
969 Reading Rd Ste N
Mason, OH 45040
Phone
(513) 604-1004
Fax
(513) 437-0571
NPI assigned
Apr 26, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 22, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 50.000837 OH Primary

Addresses

Primary practice location

969 Reading Rd Ste N
Mason, OH 45040

Mailing address

969 Reading Rd Ste N
Mason, OH 45040-2654
Phone (513) 604-1004

Other practice location 1

700 S Broadway St
Blanchester, OH 45107-1465
Phone (937) 783-2600

Other identifiers 1

IdentifierTypeStateIssuer
0080386MedicaidOH

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
50.000837OHMDPhysician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Jewish Hospital LLC Past Accepting new patients

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.

NPI Registry JSON

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

{
    "created_epoch": "1177545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587513600000",
    "number": "1104046606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "969 READING RD STE N",
            "city": "MASON",
            "state": "OH",
            "postal_code": "450402654",
            "telephone_number": "513-604-1004",
            "fax_number": "513-437-0571"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "969 READING RD STE N",
            "city": "MASON",
            "state": "OH",
            "postal_code": "45040",
            "telephone_number": "513-604-1004",
            "fax_number": "513-437-0571"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "700 S Broadway St",
            "address_purpose": "LOCATION",
            "city": "Blanchester",
            "state": "OH",
            "postal_code": "451071465",
            "country_code": "US",
            "telephone_number": "937-783-2600",
            "fax_number": "937-783-3086",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KNOOP",
        "first_name": "LAURA",
        "middle_name": "ROCHELLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-26",
        "last_updated": "2020-04-22",
        "certification_date": "2020-04-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50.000837",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0080386",
            "state": "OH"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Mason, OH

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.