Individual provider Active NPI

Jonathan Kneib, MD

  • Emergency Medicine Physician
  • Stony Brook, NY
National Provider Identifier
1871912790
Registry record updated Nov 18, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
289098 Issued in NY
Practice address
100 Nicolls Rd RM 80
Stony Brook, NY 11794-9350
Phone
(631) 444-2478
NPI assigned
Apr 8, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 18, 2021

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 289098 NY Primary

Addresses

Primary practice location

100 Nicolls Rd RM 80
Stony Brook, NY 11794-9350

Mailing address

Jonathan Kneib
P.O. Box 1554
Stony Brook, NY 11790

Electronic endpoints 1

TypeEndpointUseAffiliation
SOAP URL https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq Health Information Exchange (HIE) Southern California Permanente Medical Group

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in SC
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20231122002077 SC Practitioner - Emergency Medicine 6103196811 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Saint Louis University School of Medicine, 2014
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Broad River Physicians Group, LLCGroup PAC ID 8123385143, 70 clinicians

Practice addresses (Care Compare)

2095 Henry Tecklenburg Dr
Charleston, SC 29414-5733
Phone (843) 402-1000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
289098NYMDLicensed Practical Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Broad River Physicians Group, LLC Emergency Medicine CurrentSince Oct 1, 2023 Accepting new patients

Locations

2095 Henry Tecklenburg Dr
Charleston, SC 29414
Phone (843) 402-1037

316 Calhoun St
Charleston, SC 29401
Phone (843) 724-2000

2435 Forest Dr
Columbia, SC 29204
Phone (770) 874-6859

730 Stony Landing Rd
Moncks Corner, SC 29461
Phone (843) 572-9211

3500 N Highway 17
Mt Pleasant, SC 29466
Phone (843) 606-7000

7832 Rivers Ave
North Charleston, SC 29406
Phone (843) 824-8733

101 Sawmill Centre Dr
Summerville, SC 29483

100 Callen Blvd
Summerville, SC 29486
Phone (845) 529-3165

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.

Hospital & facility affiliations 4

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": "1396915200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1637193600000",
    "number": "1871912790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "JONATHAN KNEIB",
            "address_2": "P.O. BOX 1554",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "11790"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 NICOLLS RD RM 80",
            "city": "STONY BROOK",
            "state": "NY",
            "postal_code": "117949350",
            "telephone_number": "631-444-2478"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNEIB",
        "first_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-04-08",
        "last_updated": "2021-11-18",
        "certification_date": "2021-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "NY",
            "license": "289098",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/scalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "Southern California Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "4647 Zion Ave",
            "city": "San Diego",
            "state": "CA",
            "country_code": "US",
            "postal_code": "921202507",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Stony Brook, NY

Sources for this page

Verify at the official NPI Registry.