Individual provider Active NPI

Jenny Knaub, ANP

  • Adult Health Nurse Practitioner
  • Riverhead, NY
National Provider Identifier
1255357588
Registry record updated Mar 24, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
F301562 Issued in NY
Practice address
1279 E Main St
Riverhead, NY 11901-2583
Phone
(631) 727-2100
Fax
(631) 727-2646
NPI assigned
Jul 13, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 24, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse Practitioner 363LA2200X F301562 NY Primary

Addresses

Primary practice location

1279 E Main St
Riverhead, NY 11901-2583

Mailing address

1279 E Main St
Riverhead, NY 11901-2583
Phone (631) 727-2100

Other identifiers 1

IdentifierTypeStateIssuer
03178883MedicaidNY

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address jknaub239040@nyumc.direct-ci.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NY
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20090430000002 NY Practitioner - Nurse Practitioner 2668520701 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
State University of New York at Stony Brook, School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
New York UniversityGroup PAC ID 1355232422, 5,925 clinicians

Practice addresses (Care Compare)

111 Broadway
New York, NY 10006-1901
Phone (212) 263-9700

11700 Main Rd
Suite 7
Mattituck, NY 11952-1525
Phone (631) 963-4770

Hospital & facility affiliations

  • Suny/Stony Brook University Hospital Hospital, Stony Brook, NY, CCN 330393

Merit-based Incentive Payment System (MIPS)

Final score
90.8 of 100Reported as group
Quality
91.79
Promoting interoperability
100
Improvement activities
40
Cost
75.18

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
F301562NYMDAdult Health Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
New York University CurrentSince Oct 1, 2018 Accepting new patients
New York University CurrentSince Oct 1, 2018 Accepting new patients
Winthrop Community Medical Affiliates PC Past Accepting new patients
Nyumc Radiology Associates Past Accepting new patients

Locations

74825 Main Rd
Greenport, NY 11944
Phone (631) 477-1720

201 Manor Pl
Greenport, NY 11944
Phone (631) 477-1000

340 W Park Ave
Long Beach, NY 11561
Phone (516) 431-5064

1279 E Main St
Riverhead, NY 11901
Phone (631) 727-2100

Networks

  • Healthfirst Medicare Network H1722
  • Healthfirst Medicare Network H9678
  • Healthfirst Medicare Network H3359
  • Healthfirst Medicare Network H5989

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 and National Provider Directory roles.

Hospital & facility affiliations 6

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": "1152748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1616544000000",
    "number": "1255357588",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1279 E MAIN ST",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012583",
            "telephone_number": "631-727-2100",
            "fax_number": "631-727-2646"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1279 E MAIN ST",
            "city": "RIVERHEAD",
            "state": "NY",
            "postal_code": "119012583",
            "telephone_number": "631-727-2100",
            "fax_number": "631-727-2646"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNAUB",
        "first_name": "JENNY",
        "credential": "ANP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-13",
        "last_updated": "2021-03-24",
        "certification_date": "2021-03-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F301562",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03178883",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jknaub239040@nyumc.direct-ci.com",
            "affiliation": "N",
            "address_1": "1279 E Main St",
            "city": "Riverhead",
            "state": "NY",
            "country_code": "US",
            "postal_code": "119012583",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Riverhead, NY

Sources for this page

Verify at the official NPI Registry.