Individual provider Active NPI

Knar H Mesrobian, DO

  • Family Medicine Physician
  • Oakland, NJ
National Provider Identifier
1124412317
Registry record updated Oct 6, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
25MB10219400 Issued in NJ
Practice address
340C Ramapo Valley Rd
Oakland, NJ 07436-2711
Phone
(739) 962-6200
NPI assigned
Mar 25, 2015
Last updated
Oct 6, 2023By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 6, 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 25MB10219400 NJ Primary

Addresses

Primary practice location

340C Ramapo Valley Rd
Oakland, NJ 07436-2711

Mailing address

PO Box 416457
Boston, MA 02241-6457
Phone (844) 362-1735

Other identifiers 2

IdentifierTypeStateIssuer
80702OtherGAGEORGIA MEDICAL LICENSE
003206994BMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA, NJ2 enrollments
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 2

Enrollment IDStateProvider typePAC IDDetails
I20180829004820 GA Practitioner - Family Practice 4183974892 Reassigns benefits to 1 organization
I20231023002750 NJ Practitioner - Family Practice 4183974892 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Rowan University School of Osteopathic Medicine, 2015
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Practice Associates Medical GroupGroup PAC ID 5890703177, 1,412 clinicians

Practice addresses (Care Compare)

340 C Ramapo Valley Rd
Oakland, NJ 07436-2711
Phone (201) 416-4346

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Practice Associates Medical Group Family Medicine CurrentSince Sep 11, 2023 Accepting new patients
SJC Medical Group Inc Family Medicine CurrentSince Jul 2, 2018 Accepting new patients
Saint Josephs Medical Group Inc Family Medicine Past Accepting new patients

Locations

101 Saint Josephs Candler Dr
Ste 200
Pooler, GA 31322
Phone (912) 748-1999

11705 Mercy Blvd
Savannah, GA 31419
Phone (912) 819-2452

602 E 72nd St
Savannah, GA 31405
Phone (912) 819-7800

100 Madison Ave
Morristown, NJ 07960
Phone (973) 538-5210

465 South St
Ste 103
Morristown, NJ 07960
Phone (973) 971-7130

340C Ramapo Valley Rd
Oakland, NJ 07436
Phone (201) 416-4346

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EGDCBD
  • Direct secure messaging: kmesrobian12745@direct.ahsys.org

Organizations & group practices 3

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.

Hospital & facility affiliations 3

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1427241600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1696550400000",
    "number": "1124412317",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 416457",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022416457",
            "telephone_number": "844-362-1735"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340C RAMAPO VALLEY RD",
            "city": "OAKLAND",
            "state": "NJ",
            "postal_code": "074362711",
            "telephone_number": "739-962-6200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MESROBIAN",
        "first_name": "KNAR",
        "middle_name": "H",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-25",
        "last_updated": "2023-10-06",
        "certification_date": "2023-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NJ",
            "license": "25MB10219400",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GEORGIA MEDICAL LICENSE",
            "identifier": "80702",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "003206994B",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Oakland, NJ

Sources for this page

Verify at the official NPI Registry.