NPIMap

Individual provider Active NPI

Justin S Kroll

  • Prevention Professional
  • Port Huron, MI
National Provider Identifier
1609410596
Registry record updated Dec 10, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Prevention ProfessionalTaxonomy code 405300000X
License
1863 Issued in CT
Practice address
1902 13TH St
Port Huron, MI 48060-6238
Phone
(810) 300-8536
NPI assigned
Nov 4, 2019
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 10, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Prevention Professional 405300000X 1863 CT Primary

Addresses

Primary practice location

1902 13TH St
Port Huron, MI 48060-6238

Mailing address

1902 13TH St
Port Huron, MI 48060-6238
Phone (810) 300-8536

Other practice location 1

924 Wall St
Port Huron, MI 48060-5216
Phone (810) 300-8536

Other practice location 2

1234 Minnie St
Port Huron, MI 48060-6267
Phone (810) 300-8536

Other practice location 3

1036 Wall St
Port Huron, MI 48060-5218
Phone (810) 300-8536

Other practice location 4

1033 Wall St
Port Huron, MI 48060-5217
Phone (810) 300-8536

Other practice location 5

735 Wall St
Port Huron, MI 48060-5377
Phone (810) 300-8536

Other practice location 6

733 Wall St
Port Huron, MI 48060-5321
Phone (810) 300-8536

Other practice location 7

1319 Griswold St
Port Huron, MI 48060-5758
Phone (810) 300-8536

Other practice location 8

1220 Lapeer Ave
Port Huron, MI 48060-4352
Phone (810) 300-8536

Other practice location 9

904 Tunnel St
Port Huron, MI 48060-6374
Phone (810) 300-8536

Other identifiers 2

IdentifierTypeStateIssuer
1863MedicaidCT
0000000OtherDO NOT HAVE

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

State licenses

LicenseStateTypeSpecialty
1863CTMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Vision Quest Recovery Housing Inc CurrentSince Jan 1, 2021 Accepting new patients

Locations

1234 Minnie St
Port Huron, MI 48060

Organizations & group practices 1

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": "1572825600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607558400000",
    "number": "1609410596",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1902 13TH ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480606238",
            "telephone_number": "810-300-8536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1902 13TH ST",
            "city": "PORT HURON",
            "state": "MI",
            "postal_code": "480606238",
            "telephone_number": "810-300-8536"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "924 Wall St",
            "address_purpose": "LOCATION",
            "city": "Port Huron",
            "state": "MI",
            "postal_code": "480605216",
            "country_code": "US",
            "telephone_number": "810-300-8536",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1234 Minnie St",
            "address_purpose": "LOCATION",
            "city": "Port Huron",
            "state": "MI",
            "postal_code": "480606267",
            "country_code": "US",
            "telephone_number": "810-300-8536",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1036 Wall St",
            "address_purpose": "LOCATION",
            "city": "Port Huron",
            "state": "MI",
            "postal_code": "480605218",
            "country_code": "US",
            "telephone_number": "810-300-8536",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1033 Wall St",
            "address_purpose": "LOCATION",
            "city": "Port Huron",
            "state": "MI",
            "postal_code": "480605217",
            "country_code": "US",
            "telephone_number": "810-300-8536",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "735 Wall St",
            "address_purpose": "LOCATION",
            "city": "Port Huron",
            "state": "MI",
            "postal_code": "480605377",
            "country_code": "US",
            "telephone_number": "810-300-8536",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "733 Wall St",
            "address_purpose": "LOCATION",
            "city": "Port Huron",
            "state": "MI",
            "postal_code": "480605321",
            "country_code": "US",
            "telephone_number": "810-300-8536",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1319 Griswold St",
            "address_purpose": "LOCATION",
            "city": "Port Huron",
            "state": "MI",
            "postal_code": "480605758",
            "country_code": "US",
            "telephone_number": "810-300-8536",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1220 Lapeer Ave",
            "address_purpose": "LOCATION",
            "city": "Port Huron",
            "state": "MI",
            "postal_code": "480604352",
            "country_code": "US",
            "telephone_number": "810-300-8536",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "904 Tunnel St",
            "address_purpose": "LOCATION",
            "city": "Port Huron",
            "state": "MI",
            "postal_code": "480606374",
            "country_code": "US",
            "telephone_number": "810-300-8536",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "KROLL",
        "first_name": "JUSTIN",
        "middle_name": "S",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-11-04",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "405300000X",
            "taxonomy_group": "",
            "desc": "Prevention Professional",
            "state": "CT",
            "license": "1863",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1863",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DO NOT HAVE",
            "identifier": "0000000",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Port Huron, MI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2020; 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.