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PETER FORD KNICKERBOCKER DO
NPI 1336432608
Pediatrics - Neonatal-Perinatal Medicine in Jacksonville, FL

Active since May 19, 2011PECOS EnrolledAccepts Medicare Assignment
BLDG H 2005 KNIGHT LANE, NAVY MEDICINE SUPPORT COMMAND, JACKSONVILLE, FL 32212(215) 298-2476 Get Directions Write a Review

NPPES record last updated: March 23, 2023. Verified against the NPPES registry weekly; last sync: October 18, 2026.

Record update history: Mar 23, 2023, May 19, 2022 (2 updates tracked since 2022).

About Peter Ford Knickerbocker Do NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

PETER FORD KNICKERBOCKER DO (NPI 1336432608) is an individual neonatal-perinatal medicine provider in Jacksonville, Florida, licensed in California (20A12420) and active in the NPI registry since May 2011. He is enrolled in Medicare PECOS and is a graduate of Philadelphia College Of Osteopathic Medicine (2011).

NPPES Registry Identity

NPI1336432608
Entity TypeIndividualMale
Primary Taxonomy2080N0001X
Provider Legal NamePETER FORD KNICKERBOCKERCredential: DO
Location AddressBLDG H 2005 KNIGHT LANE, NAVY MEDICINE SUPPORT COMMANDJacksonville, FL 32212-0140
Mailing Address3435 Gurnard CtSan Diego, CA 92124-3304 · (215) 298-2476
Phone(215) 298-2476
Sole ProprietorNo
Medical School CMSPhiladelphia College Of Osteopathic MedicineGraduated 2011
Enumeration DateMay 19, 2011
Last NPPES UpdateMarch 23, 20232 updates tracked since enumeration
NPPES CertifiedMarch 23, 2023
✔ NPI 1336432608 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPediatrics · Neonatal-Perinatal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code2080N0001X
License✔ Licensed in CA · 20A12420
Definition
A pediatrician who is the principal care provider for sick newborn infants. Clinical expertise is used for direct patient care and for consulting with obstetrical colleagues to plan for the care of mothers who have high-risk pregnancies.
Also ListedStudent in an Organized Health Care Education/Training ProgramTaxonomy 390200000X
BLDG H 2005 KNIGHT LANE, Jacksonville, FL 32212
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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Peter Ford Knickerbocker Do is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID7416337696
PECOS Enrollment IDI20220706000793
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Peter Knickerbocker reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Southern California Permanente Medical Group
2,085 mi
Health Maintenance Organization
4647 ZION AVE
San Diego, CA 92120
  • Reassigned Medicare billing, California enrollment
  • 13,921 clinicians in this Medicare group
NPI 1225060742 (619) 528-5000

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 17

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

AMIE HEIM DDS
Dentist
BLDG H 2005 KNIGHT LANE, NAVY MEDICINE SUPPORT COMMAND ATTN: MEDICAL STAFF SVCS
JACKSONVILLE, FL 32212
Duval County (760) 725-5102
MRS. ADRIENNE MARIA GUENTHER RPH
Pharmacist
BLDG H 2005 KNIGHT LANE, ATTN;MEDICAL STAFF SERVICES ,NAVY MEDICINE SUPPORT COMM
JACKSONVILLE, FL 32212
Duval County (904) 542-7200
TAE YUNG KIM DMD
Dentist (General Practice)
BLDG H 2005 KNIGHT LANE, NAVY MEDICINE SUPPORT COMMAND ATTN: MEDICAL STAFF SVCS
JACKSONVILLE, FL 32212
Duval County (760) 725-0140
MS. AMY LYNN TRAMALONI NNP
Nurse Practitioner (Neonatal, Critical Care)
BLDG H 2005 KNIGHT LANE, NAVY MEDICAL SUPPORT COMMAND
JACKSONVILLE, FL 32212
Duval County (760) 725-9457
DR. DYLAN CAHILL ARNOLD DO
Emergency Medicine
BLDG H 2005 KNIGHT LANE, NAVY MEDICINE SUPPORT COMMAND, DMHRSI TEAM
JACKSONVILL, FL 32212
Duval County (757) 635-4579
DR. SHAY RAZMI
Dentist (General Practice)
BLDG H 2005 KNIGHT LANE, NAVY MEDICINE SUPPORT COMMAND ATTN: MEDICAL STAFF SVCS
JACKSONVILLE, FL 32212
Duval County (760) 725-2331
DI KHOO M.D.
Military Health Care Provider
BLDG H 2005 KNIGHT LANE, ATTN: MEDICAL STAFF SERVICES. NAVY MEDICINE SUPPORT COM
JACKSONVILLE, FL 32212
Duval County (619) 532-6400
DR. ANDRE CHARLES SANTOS D.D.S.
Dentist
BLDG H 2005 KNIGHT LANE, NAVY MEDICINE SUPPORT COMMAND ATTN:MEDICAL STAFF SVCS
JACKSONVILLE, FL 32212
Duval County (760) 725-5102

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Peter Knickerbocker's NPI number?

The NPI number for Peter Knickerbocker is 1336432608. It was assigned to this individual provider in the NPPES registry on May 19, 2011.

Where is Peter Knickerbocker located?

Peter Knickerbocker practices at Bldg H 2005 Knight Lane Navy Medicine Support Command, Jacksonville, FL 32212. The listed phone number is (215) 298-2476.

What is Peter Knickerbocker's specialty?

The primary specialty registered for this NPI is Pediatrics, specializing in Neonatal-Perinatal Medicine, with taxonomy code 2080N0001X.

Is Peter Knickerbocker enrolled in Medicare?

Yes. Peter Knickerbocker is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organization bills Medicare for Peter Knickerbocker's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Peter Knickerbocker reassigns Medicare benefits to Southern California Permanente Medical Group (San Diego, CA). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Peter Knickerbocker's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

When was this NPI record last updated?

The NPPES record for Peter Knickerbocker was last updated on March 23, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.