Derek Koll

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

11754 Issued in MN

Practice address

109 5TH St NE
Little Falls, MN 56345-2732

Phone

(320) 631-1104

Fax

(320) 631-1105

NPI assigned

Jul 3, 2018

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in MN

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

Other, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

St Cloud HospitalGroup PAC ID 4880594779, 215 clinicians

Centracare ClinicGroup PAC ID 2466363395, 800 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: dkoll579363@direct.centracare.com

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.

• St. Cloud Hospital

  • General Acute Care Hospital
  • Saint Cloud, MN
  • NPI 1043269798
  Medicare reassignment Care Compare group NPD
• Centracare Clinic

  • Multi-Specialty Clinic/Center
  • St Cloud, MN
  • NPI 1043212665
  Medicare reassignment Care Compare group
• Stellar Health Care

  • Physical Therapy Clinic/Center
  • Howard Lake, MN
  • NPI 1174556682
  Medicare reassignment NPD
• St. Cloud Hospital

  • Physical Therapy Clinic/Center
  • Saint Cloud, MN
  • NPI 1679088157
  Medicare reassignment
• St Cloud Hospital

  • Substance Use Disorder Rehabilitation Hospital Unit
  • Saint Cloud, MN
  • NPI 1811150618
  NPD

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

{
    "created_epoch": "1530576000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1679875200000",
    "number": "1255827119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 737",
            "city": "HOWARD LAKE",
            "state": "MN",
            "postal_code": "553490737",
            "telephone_number": "320-543-1103",
            "fax_number": "320-543-1105"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "109 5TH ST NE",
            "city": "LITTLE FALLS",
            "state": "MN",
            "postal_code": "563452732",
            "telephone_number": "320-631-1104",
            "fax_number": "320-631-1105"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLL",
        "first_name": "DEREK",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-07-03",
        "last_updated": "2023-03-27",
        "certification_date": "2023-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MN",
            "license": "11754",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "dkoll579363@direct.centracare.com",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "dkoll579363@direct.centracare.com",
            "address_1": "1301 33rd St S",
            "city": "Saint Cloud",
            "state": "MN",
            "country_code": "US",
            "postal_code": "563019604",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Jeanne Catherine Kenning Smith, LADC
• Thomas Edward Klecker, LICSW LP
• Rachel Mary Kleinschmidt, PA-C
• Mary Therese Klinker, M.D.
• James Paul Kofoed, DC
• Janet Kay Korzeniowski, RD, LD, CDE
• Ryan David Kray, M.D.
• Christina M Krippner, PA-C
• Moriah Gabrielle Krueger, LPCC
• L F Taxi LLC

• Physical Therapist in Little Falls, MN
• Providers in Little Falls, MN by specialty
• Physical Therapist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2023; 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.