NPIMap

Individual provider Active NPI

Carrie E. Knoll, M.D.

  • Pediatrics Physician
  • Pomona, CA
National Provider Identifier
1255302238
Registry record updated Mar 7, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
License
G77415 Issued in CA
Practice address
250 W Bonita Ave
#200
Pomona, CA 91767-1850
Phone
(909) 629-5067
Fax
(909) 865-7688
NPI assigned
Jan 30, 2006
Last updated
Mar 7, 2023By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 7, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X G77415 CA Primary

Addresses

Primary practice location

250 W Bonita Ave
#200
Pomona, CA 91767-1850

Mailing address

250 W Bonita Ave
#200
Pomona, CA 91767-1850
Phone (909) 629-5067

Other identifiers 1

IdentifierTypeStateIssuer
163180OtherCAAAP #

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)
Not enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
G77415CAMDPediatrics Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Hollenberg Agrawal Knoll Warren Hong Fung Tillis Kaushal MDS Pediatrics Past Accepting new patients
Pomona Valley Hospital Medical Center Past Accepting new patients
Pediatric Subspecialty Faculty, Inc. Pediatrics Past Accepting new patients
Children's Hospital of Orange County Past Accepting new patients

Networks

  • BSC 65 PLUS INDIVIDUAL MAPD

Organizations & group practices 4

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": "1138579200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1255302238",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "250 W BONITA AVE",
            "address_2": "#200",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917671850",
            "telephone_number": "909-629-5067",
            "fax_number": "909-865-7688"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "250 W BONITA AVE",
            "address_2": "#200",
            "city": "POMONA",
            "state": "CA",
            "postal_code": "917671850",
            "telephone_number": "909-629-5067",
            "fax_number": "909-865-7688"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNOLL",
        "first_name": "CARRIE",
        "middle_name": "E.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-30",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G77415",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AAP #",
            "identifier": "163180",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Pomona, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; 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.