NPIMap

Individual provider Active NPI

Charles I. Knoll, M.D.

  • Physical Medicine & Rehabilitation Physician
  • Rancho Mirage, CA
National Provider Identifier
1962443945
Registry record updated Nov 5, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X
License
A100046 Issued in CA
Practice address
39000 Bob Hope Dr
Annenberg 2 West
Rancho Mirage, CA 92270-3221
Phone
(760) 834-7870
Fax
(760) 834-7871
NPI assigned
Jun 9, 2006
Last updated
Nov 5, 2021By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 5, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Medicine & Rehabilitation Physician 208100000X MD27724 OR
Physical Medicine & Rehabilitation Physician 208100000X A100046 CA Primary

Addresses

Primary practice location

39000 Bob Hope Dr
Annenberg 2 West
Rancho Mirage, CA 92270-3221

Mailing address

39000 Bob Hope Dr
Annenberg 2 West
Rancho Mirage, CA 92270-3221
Phone (760) 834-7870

Other identifiers 1

IdentifierTypeStateIssuer
403418000MedicaidMD

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address cknoll1657912@oc.providencedirect.org

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20081212000270 CA Practitioner - Physical Medicine and Rehabilitation 7416040860 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physical Medicine and Rehabilitation
Education
Virginia Commonwealth University, School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Providence Medical FoundationGroup PAC ID 8921993205, 1,461 clinicians

Practice addresses (Care Compare)

2700 Dolbeer St
Eureka, CA 95501-4736
Phone (707) 445-8121

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD27724ORMDPhysical Medicine & Rehabilitation Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Providence Medical Foundation Current Accepting new patients
Providence Medical Foundation CurrentSince Jan 14, 2019 Accepting new patients
Hospice of Humboldt Inc CurrentSince Dec 1, 2025 Accepting new patients
Providence Medical Foundation CurrentSince Jan 14, 2019 Accepting new patients
Eisenhower Medical Center Past Accepting new patients

Locations

2700 Dolbeer St
Eureka, CA 95501
Phone (707) 269-4229

3327 Timber Fall Ct
Eureka, CA 95503
Phone (707) 445-8443

1165 Montgomery Dr
#1112
Santa Rosa, CA 95405
Phone (707) 546-3210

500 Doyle Park Dr
Ste 100
Santa Rosa, CA 95405
Phone (714) 449-4842

Interoperability endpoints

  • Direct secure messaging: cknoll1657912@oc.providencedirect.org

Ownership & related parties

All facility ownership & control disclosures 1

Facilities whose Medicare enrollment lists this provider’s PECOS associate ID as an owner or managing party.

FacilityTypeRoleSince
Hospice of Humboldt, Inc.Eureka, CA, CCN 051536 Hospice W-2 Managing Employee (5%) Dec 1, 2025

Owned or controlled facilities with NPI records 1

Facilities whose Medicare enrollment lists this provider as an owner, officer, director or managing party.

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

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": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1636070400000",
    "number": "1962443945",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39000 BOB HOPE DR",
            "address_2": "ANNENBERG 2 WEST",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922703221",
            "telephone_number": "760-834-7870",
            "fax_number": "760-834-7871"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39000 BOB HOPE DR",
            "address_2": "ANNENBERG 2 WEST",
            "city": "RANCHO MIRAGE",
            "state": "CA",
            "postal_code": "922703221",
            "telephone_number": "760-834-7870",
            "fax_number": "760-834-7871"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KNOLL",
        "first_name": "CHARLES",
        "middle_name": "I.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2021-11-05",
        "certification_date": "2021-11-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "OR",
            "license": "MD27724",
            "primary": false
        },
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "CA",
            "license": "A100046",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "403418000",
            "state": "MD"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cknoll1657912@oc.providencedirect.org",
            "affiliation": "N",
            "address_1": "2700 Dolbeer St",
            "city": "Eureka",
            "state": "CA",
            "country_code": "US",
            "postal_code": "955014736",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Rancho Mirage, CA

Sources for this page

Verify at the official NPI Registry.