NPIMap

Individual provider Active NPI

Peter B Kroll, M.D.

  • Pain Medicine (Anesthesiology) Physician
  • Hendersonville, TN
National Provider Identifier
1124020011
Registry record updated Jul 14, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
MD36963 Issued in TN
Practice address
353 New Shackle Island Rd
Suite 122B
Hendersonville, TN 37075-2379
Phone
(615) 824-3737
Fax
(855) 540-4722
NPI assigned
Aug 11, 2005
Last updated
Jul 14, 2015By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 14, 2015

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Anesthesiology) Physician 207LP2900X MD0000036963 TN
Anesthesiology Physician 207L00000X 36963 TN
Anesthesiology Physician 207L00000X MD36963 TN
Pain Medicine (Anesthesiology) Physician 207LP2900X MD36963 TN Primary

Addresses

Primary practice location

353 New Shackle Island Rd
Suite 122B
Hendersonville, TN 37075-2379

Mailing address

131 Saundersville Road
160
Hendersonville, TN 37075
Phone (615) 824-3737

Other identifiers 6

IdentifierTypeStateIssuer
P00450337OtherTNRAILROAD MEDICARE
7502422OtherTNAETNA
3377000MedicaidTN
10069948OtherTNAMERIGROUP
3878748MedicaidTN
4129006OtherTNBCBS

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
HHS exclusion list flag
CMS’s directory marks this NPI as on an HHS exclusion list; no matching OIG record was found. The OIG exclusions file (LEIE) holds no record for this NPI, and the directory does not say which list the flag comes from. How exclusions are shown Confirm with the OIG exclusions search.
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD0000036963TNMDPain Medicine (Anesthesiology) Physician
MD36963TNMDPain Medicine (Anesthesiology) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Vision Laboratory Solutions LLC PastSince Nov 16, 2015 Accepting new patients
East Tennessee Neuropathy, PC PastSince Apr 1, 2013 Accepting new patients

Organizations & group practices 70

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.

View all 70

NPI Registry JSON

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

{
    "created_epoch": "1123718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436832000000",
    "number": "1124020011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 SAUNDERSVILLE ROAD",
            "address_2": "160",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "37075",
            "telephone_number": "615-824-3737",
            "fax_number": "855-540-4722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "353 NEW SHACKLE ISLAND RD",
            "address_2": "SUITE 122B",
            "city": "HENDERSONVILLE",
            "state": "TN",
            "postal_code": "370752379",
            "telephone_number": "615-824-3737",
            "fax_number": "855-540-4722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KROLL",
        "first_name": "PETER",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-11",
        "last_updated": "2015-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "TN",
            "license": "MD0000036963",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TN",
            "license": "36963",
            "primary": false
        },
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "TN",
            "license": "MD36963",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "TN",
            "license": "MD36963",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00450337",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7502422",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3377000",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "10069948",
            "state": "TN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3878748",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4129006",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hendersonville, TN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.