Active NPI
Wayne S. Knesebeck, P.C.
- Specialist
- Ashtabula, OH
National Provider Identifier
1275738551
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- OHIO LIC C0501083
- Practice address
- 4200 Park Ave
3Rd Floor
Ashtabula, OH 44004-6887 - Phone
- (440) 992-2121
- Fax
- (440) 992-5974
- NPI assigned
- Jun 18, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | OHIO LIC C0501083 | OH | Primary |
Addresses
Primary practice location
4200 Park Ave
3Rd Floor
Ashtabula, OH 44004-6887
Mailing address
4200 Park Ave
3Rd Floor
Ashtabula, OH 44004-6887
Phone (440) 992-2121
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1851352959 | Other | OH | GROUP NPI NUMBER |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OHIO LIC C0501083 | OH | MD | Specialist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Catholic Charities of Ashtabula County | 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.
-
- Adult Mental Health Clinic/Center
- Ashtabula, OH
- NPI 1851352959
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1182124800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1275738551",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4200 PARK AVE",
"address_2": "3RD FLOOR",
"city": "ASHTABULA",
"state": "OH",
"postal_code": "440046887",
"telephone_number": "440-992-2121",
"fax_number": "440-992-5974"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4200 PARK AVE",
"address_2": "3RD FLOOR",
"city": "ASHTABULA",
"state": "OH",
"postal_code": "440046887",
"telephone_number": "440-992-2121",
"fax_number": "440-992-5974"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KNESEBECK",
"first_name": "WAYNE",
"middle_name": "S.",
"name_prefix": "Mr.",
"credential": "P.C.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-06-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "OH",
"license": "OHIO LIC C0501083",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GROUP NPI NUMBER",
"identifier": "1851352959",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ashtabula, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.