Active NPI
Matthew Robert Kroll
- Hematology & Oncology Physician
- Iowa City, IA
National Provider Identifier
1629630116
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Hematology & Oncology Physician
- License
- R-12686
- Practice address
- 200 Hawkins Dr
Iowa City, IA 52242-1009 - Phone
- (319) 353-7800
- NPI assigned
- Jul 3, 2019
- Reactivated
- Jul 1, 2020
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 402247 | IL | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Hematology & Oncology Physician | 207RH0003X | R-12686 | IA | Primary |
Addresses
Primary practice location
200 Hawkins Dr
Iowa City, IA 52242-1009
Mailing address
200 Hawkins Dr
Iowa City, IA 52242-1009
Other practice location 1
600 S Paulina St Ste 403
Chicago, IL 60612-3806
Phone (312) 942-7100
Other practice location 2
2160 S 1st Ave
Maywood, IL 60153-3328
Phone (708) 216-7766
Other practice location 3
2160 S 1st Ave
Maywood, IL 60153-3328
Phone (708) 216-7766
Other practice location 4
2160 S 1st Ave
Maywood, IL 60153-3328
Phone (708) 216-7766
Other practice location 5
2160 S 1st Ave
Maywood, IL 60153-3328
Phone (708) 216-7766
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 402247 | IL | MD | Internal Medicine Physician |
| R-12686 | IA | MD | Hematology & Oncology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1562112000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1688601600000",
"number": "1629630116",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 HAWKINS DR",
"city": "IOWA CITY",
"state": "IA",
"postal_code": "522421009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 HAWKINS DR",
"city": "IOWA CITY",
"state": "IA",
"postal_code": "522421009",
"telephone_number": "319-353-7800"
}
],
"practiceLocations": [
{
"address_1": "600 S Paulina St Ste 403",
"address_purpose": "LOCATION",
"city": "Chicago",
"state": "IL",
"postal_code": "606123806",
"country_code": "US",
"telephone_number": "312-942-7100",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2160 S 1st Ave",
"address_purpose": "LOCATION",
"city": "Maywood",
"state": "IL",
"postal_code": "601533328",
"country_code": "US",
"telephone_number": "708-216-7766",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2160 S 1st Ave",
"address_purpose": "LOCATION",
"city": "Maywood",
"state": "IL",
"postal_code": "601533328",
"country_code": "US",
"telephone_number": "708-216-7766",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2160 S 1st Ave",
"address_purpose": "LOCATION",
"city": "Maywood",
"state": "IL",
"postal_code": "601533328",
"country_code": "US",
"telephone_number": "708-216-7766",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2160 S 1st Ave",
"address_purpose": "LOCATION",
"city": "Maywood",
"state": "IL",
"postal_code": "601533328",
"country_code": "US",
"telephone_number": "708-216-7766",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "KROLL",
"first_name": "MATTHEW",
"middle_name": "ROBERT",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2019-07-03",
"last_updated": "2023-07-06",
"certification_date": "2023-07-06",
"deactivation_date": "2020-05-15",
"reactivation_date": "2020-07-01",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "IL",
"license": "402247",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207RH0003X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Internal Medicine, Hematology & Oncology",
"state": "IA",
"license": "R-12686",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Iowa City, IA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.