Jacob Knopik, CERTIFIED PEER SUPPO

Key facts

NPI

1831817030

Entity type

Individual (NPI type 1)

Primary specialty

Peer Specialist 175T00000X

Practice address

101 East Broadway Avenue
Bismark, ND 58501

Phone

(701) 222-0386

Fax

(701) 255-4891

NPI assigned

Aug 15, 2022

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 15, 2022.

{
    "created_epoch": "1660521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660521600000",
    "number": "1831817030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 EAST BROADWAY AVENUE",
            "city": "BISMARK",
            "state": "ND",
            "postal_code": "58501",
            "telephone_number": "701-222-0386",
            "fax_number": "701-255-4891"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 EAST BROADWAY AVENUE",
            "city": "BISMARK",
            "state": "ND",
            "postal_code": "58501",
            "telephone_number": "701-222-0386",
            "fax_number": "701-255-4891"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNOPIK",
        "first_name": "JACOB",
        "credential": "CERTIFIED PEER SUPPO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-08-15",
        "last_updated": "2022-08-15",
        "certification_date": "2022-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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