Individual provider Active NPI

Reed Kroncke, PT

  • Physical Therapist
  • Severna Park, MD
National Provider Identifier
1083640692
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physical TherapistTaxonomy code 225100000X
License
21300 Issued in MD
Practice address
109 Sabrina LN # B
Severna Park, MD 21146-1612
Phone
(410) 544-7484
NPI assigned
Jun 24, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physical Therapist 225100000X 21300 MD Primary

Addresses

Primary practice location

109 Sabrina LN # B
Severna Park, MD 21146-1612

Mailing address

1300 Ritchie Hwy
Suite E
Arnold, MD 21012
Phone (410) 975-9832

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041216000849 MD Practitioner - Physical Therapist in Private Practice 4981661337 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physical Therapist in Private Practice
Education
Other, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

382 Thompson Creek Mall
Stevensville, MD 21666-2593
Phone (443) 249-3281

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
21300MDMDPhysical Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Key Physical Therapy & Sports Rehabilitation Physical Therapist CurrentSince Sep 1, 2021 Accepting new patients
Bayside Physical Therpay and Sports Rehabilitation, Inc Physical Therapist PastSince Oct 5, 2015 Accepting new patients

Locations

382 Thompson Creek Mall
Stevensville, MD 21666
Phone (443) 249-3281

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151107200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1083640692",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1300 RITCHIE HWY",
            "address_2": "SUITE E",
            "city": "ARNOLD",
            "state": "MD",
            "postal_code": "21012",
            "telephone_number": "410-975-9832",
            "fax_number": "410-975-9834"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 SABRINA LN # B",
            "city": "SEVERNA PARK",
            "state": "MD",
            "postal_code": "211461612",
            "telephone_number": "410-544-7484"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KRONCKE",
        "first_name": "REED",
        "credential": "PT",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MD",
            "license": "21300",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Severna Park, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.