Active NPI
Kenneth M Zoller, MD
- Nephrology Physician
- Brockton, MA
National Provider Identifier
1174563209
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nephrology Physician
- License
- 38302
- Practice address
- 375 Westgate Dr
Brockton, MA 02301-1818 - Phone
- (508) 587-0700
- Fax
- (508) 587-0287
- NPI assigned
- Jun 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician | 207RN0300X | 38302 | MA | Primary |
Addresses
Primary practice location
375 Westgate Dr
Brockton, MA 02301-1818
Mailing address
375 Westgate Dr
Brockton, MA 02301-1818
Phone (508) 587-0700
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0128252 | Medicaid | MA | |
| BLUE CROSS/SHIELD | Other | MA | J03214 |
| UNITED HEALTH CARE | Other | MA | 31-02002 |
| AETNA | Other | MA | 0597915 |
| HARVARD PILGRIM | Other | MA | 10306 |
| HEALTH NET | Other | MA | 000000005592 |
| TUFTS | Other | MA | 038302 |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 38302 | MA | MD | Nephrology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1149638400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174563209",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "375 WESTGATE DR",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023011818",
"telephone_number": "508-587-0700",
"fax_number": "508-587-0287"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "375 WESTGATE DR",
"city": "BROCKTON",
"state": "MA",
"postal_code": "023011818",
"telephone_number": "508-587-0700",
"fax_number": "508-587-0287"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ZOLLER",
"first_name": "KENNETH",
"middle_name": "M",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-06-07",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207RN0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Nephrology",
"state": "MA",
"license": "38302",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0128252",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "J03214",
"identifier": "BLUE CROSS/SHIELD",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "31-02002",
"identifier": "UNITED HEALTH CARE",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "0597915",
"identifier": "AETNA",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "10306",
"identifier": "HARVARD PILGRIM",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "000000005592",
"identifier": "HEALTH NET",
"state": "MA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "038302",
"identifier": "TUFTS",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Brockton, MA
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.