Individual provider Active NPI

Clinton Eugene Knoell, HAD

  • Hearing Instrument Specialist
  • Red Oak, IA
National Provider Identifier
1578636908
Registry record updated Jan 25, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hearing Instrument SpecialistTaxonomy code 237700000X
License
00862 Issued in IA
Practice address
411 E Reed St
Red Oak, IA 51566-2372
Phone
(712) 623-2565
NPI assigned
Nov 15, 2006
Last updated
Jan 25, 2022By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 25, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hearing Instrument Specialist 237700000X 00862 IA Primary

Addresses

Primary practice location

411 E Reed St
Red Oak, IA 51566-2372

Mailing address

2519 S 16TH St
Council Bluffs, IA 51501-7569
Phone (712) 623-2565

Other practice location 1

711 W Sheridan Ave
Shenandoah, IA 51601-1741
Phone (712) 623-2565

Other practice location 2

111 N 15th St
Clarinda, IA 51632-1614
Phone (712) 623-2565

Other identifiers 1

IdentifierTypeStateIssuer
0463398MedicaidIA

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

LicenseStateTypeSpecialty
00862IAMDHearing Instrument Specialist

NPI Registry JSON

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

{
    "created_epoch": "1163548800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1643068800000",
    "number": "1578636908",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2519 S 16TH ST",
            "city": "COUNCIL BLUFFS",
            "state": "IA",
            "postal_code": "515017569",
            "telephone_number": "712-623-2565"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "411 E REED ST",
            "city": "RED OAK",
            "state": "IA",
            "postal_code": "515662372",
            "telephone_number": "712-623-2565"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "711 W Sheridan Ave",
            "address_purpose": "LOCATION",
            "city": "Shenandoah",
            "state": "IA",
            "postal_code": "516011741",
            "country_code": "US",
            "telephone_number": "712-623-2565",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "111 N 15th St",
            "address_purpose": "LOCATION",
            "city": "Clarinda",
            "state": "IA",
            "postal_code": "516321614",
            "country_code": "US",
            "telephone_number": "712-623-2565",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KNOELL",
        "first_name": "CLINTON",
        "middle_name": "EUGENE",
        "credential": "HAD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-15",
        "last_updated": "2022-01-25",
        "certification_date": "2022-01-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "237700000X",
            "taxonomy_group": "",
            "desc": "Hearing Instrument Specialist",
            "state": "IA",
            "license": "00862",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0463398",
            "state": "IA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Red Oak, IA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 25, 2022; 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.