NPIMap

Individual provider Active NPI

Jeffery D. Kroll, MD

  • Urology Physician
  • Temple, TX
National Provider Identifier
1073509188
Registry record updated Oct 1, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urology PhysicianTaxonomy code 208800000X
License
H0537 Issued in TX
Practice address
1905 SW H K Dodgen Loop
Temple, TX 76502-1814
Phone
(254) 298-2682
Fax
(254) 778-7197
NPI assigned
Sep 23, 2005
Last updated
Oct 1, 2012By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 1, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urology Physician 208800000X H0537 TX Primary

Addresses

Primary practice location

1905 SW H K Dodgen Loop
Temple, TX 76502-1814

Mailing address

1905 SW H K Dodgen Loop
Temple, TX 76502-1814
Phone (254) 298-2682

Other identifiers 1

IdentifierTypeStateIssuer
123033604MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX
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
I20100225000374 TX Practitioner - Urology 5092852541 Reassigns benefits to 5 organizations

Care Compare profile

Medicare Care Compare
Specialty
Urology
Education
University of Texas Southwestern Medical School at Dallas, 1985
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1050 E Loop
304 Crockett Medical Center Clinic
Crockett, TX 75835-1814
Phone (979) 543-6251

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Mid Coast Medical Center Crockett Inc CurrentSince Jun 1, 2018 Accepting new patients
Crockett Medical Center, LLC Urology CurrentSince Jun 1, 2018 Accepting new patients
Vpa of Texas PLLC CurrentSince Jul 1, 2021 Accepting new patients
Vpa of Texas PLLC CurrentSince Jul 1, 2021 Accepting new patients
Signify Health Medical Associates, PLLC CurrentSince Jul 1, 2021 Accepting new patients
Mid Coast Medical Center Crockett Inc Past Accepting new patients
GS Physician Services Past Accepting new patients

Locations

1050 E Loop 304
Crockett, TX 75835
Phone (936) 544-2236

1050 E Loop 304
Ste 200
Crockett, TX 75835
Phone (936) 544-5132

1100 E Loop 304
Crockett, TX 75835
Phone (936) 546-3862

4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037

4545 Fuller Dr
Ste 325
Irving, TX 75038
Phone (972) 870-5511

Interoperability endpoints

  • FHIR API: https://api.platform.athenahealth.com/17821/brand/1/csg/1/fhir/r4
  • FHIR API: https://fhir-myrecord.cerner.com/r4/b4348b5b-bd9c-4bea-a3a3-0691137fbf46/

Organizations & group practices 7

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 1

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": "1127433600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1349049600000",
    "number": "1073509188",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1905 SW H K DODGEN LOOP",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765021814",
            "telephone_number": "254-298-2682",
            "fax_number": "254-778-7197"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1905 SW H K DODGEN LOOP",
            "city": "TEMPLE",
            "state": "TX",
            "postal_code": "765021814",
            "telephone_number": "254-298-2682",
            "fax_number": "254-778-7197"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KROLL",
        "first_name": "JEFFERY",
        "middle_name": "D.",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-23",
        "last_updated": "2012-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "",
            "desc": "Urology",
            "state": "TX",
            "license": "H0537",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "123033604",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Temple, TX

Sources for this page

Verify at the official NPI Registry.