Pamela Rose Knickerbocker, D.O.
Individual provider Active NPI Family Medicine Physician · Avon Park, FL
NPI 1164561353 · NPPES record last updated Feb 16, 2023
Key facts
- NPI
- 1164561353
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- OS19486 (FL)
- Practice address
- 1006 W Pleasant St
Avon Park, FL 33825-2966 - Phone
- (863) 453-3121
- Fax
- (863) 452-2823
- NPI assigned
- Feb 5, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 14
Hospital & facility affiliations 3
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Oklahoma State University College of Osteopathic Medicine, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Adventist Health System-Sunbelt Inc
Practice addresses (Care Compare)
1210 US Hwy 27 N
Lake Placid, FL 33852-7948
Phone (863) 465-3777
4325 Sun N Lake Blvd
Sebring, FL 33872-2171
6325 US Hwy 27 N
Sebring, FL 33870-8226
Phone (863) 471-3926
Hospital & facility affiliations
- Centerwell Home Health
- Adventhealth Sebring
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in CA, FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20150819009313 | CA | Practitioner - General Practice | 0345313979 | Reassigns benefits to 2 organizations |
| I20230225000415 | FL | Practitioner - Family Practice | 0345313979 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4409 | OK | MD | Mental Health Counselor |
| A2012777 | CA | MD | Family Medicine Physician |
| 12777 | CA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dignity Health | Current |
Accepting new patients | |
| Adventist Health System-Sunbelt Inc | Current |
Accepting new patients | |
| Adventist Health System-Sunbelt Inc | Family Medicine | Current |
Accepting new patients |
| Shasta Community Health Center | Family Medicine | Current |
Accepting new patients |
| Shasta Community Health Center | Current |
Accepting new patients | |
| Dignity Health | Current |
Accepting new patients | |
| Shasta Community Health Center | Current | Accepting new patients | |
| Adventist Health System-Sunbelt Inc | Family Medicine | Past | Accepting new patients |
| Adventist Health System-Sunbelt Inc | Family Medicine | Past | Accepting new patients |
Locations
1035 Placer St
Redding, CA 96001
2480 Sonoma St
Redding, CA 96001
Phone (530) 225-6090
2175 Rosaline Ave
Redding, CA 96001
Phone (530) 225-7247
310 Hartnell Ave
Ste Ac
Redding, CA 96002
Phone (530) 225-6390
4215 Front St
Shasta Lake, CA 96019
Phone (530) 246-5896
1006 W Pleasant St
Avon Park, FL 33825
Phone (863) 453-3121
1210 US Highway 27 N
Lake Placid, FL 33852
Phone (863) 465-3777
6325 US 27 N
Ste 201
Sebring, FL 33870
Phone (863) 382-9600
Interoperability endpoints
- pknickerbocker1030647@adventhealth.direct-ci.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | A2012777 | CA | |
| Family Medicine Physician | 207Q00000X | OS19486 | FL | Yes |
| Family Medicine Physician | 207Q00000X | 4409 | OK |
Addresses
Primary practice location
1006 W Pleasant St
Avon Park, FL 33825-2966
Mailing address
1035 Placer St
Redding, CA 96001-1125
Phone (530) 246-5710
Other practice location 1
4215 Front St
Shasta Lake, CA 96019-9430
Phone (530) 246-5896
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 200182150A | Medicaid | OK |
Other names
- Pamela Rose Garner
Other providers in Avon Park, FL
- Michael Ray Karr
- Victoria Frances Kennedy
- Khurana Family Medicine M.D., P.a.
- Sunaina Khurana
- Brittany Lee-Ann King
- J. Agustin Lacson
- Arleen Ann Lally
- Long Lam
- Ashlynne Feely Langford
- Patrick Dennis Lavallie
All providers in Avon Park, FL · Family Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 16, 2023. 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.
- Order and Referring (CMS).
- 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.