Matthew Tyler Kroll, MD
Individual provider Active NPI Family Medicine Physician · Green Bay, WI
NPI 1760061865 · NPPES record last updated Jul 3, 2024
Key facts
- NPI
- 1760061865
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 81365-20 (WI)
- Practice address
- 1630 Commanche Ave
Green Bay, WI 54313-5753 - Phone
- (920) 430-4700
- NPI assigned
- Apr 6, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 15
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Bellin Memorial Hospital Inc
Practice addresses (Care Compare)
1630 Commanche Ave
Green Bay, WI 54313-5753
Phone (920) 430-4700
Hospital & facility affiliations
- Bellin Home Health Agency
- Unity Hospice
- Bellin Memorial Hospital
- Rennes Health and Rehab Center-De Pere
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Removal of skin lesions | 1-10 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20240712001169 | WI | Practitioner - Family Practice | 3779941356 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Oconto Hospital & Medical Center, Inc. | Family Medicine | Current |
Accepting new patients |
| Oconto Hospital & Medical Center Inc | Current | Accepting new patients | |
| Bellin Memorial Hospital Inc | Family Medicine | Current |
Accepting new patients |
| Bellin Memorial Hospital Inc | Current |
Accepting new patients | |
| Bellin Memorial Hospital Inc | Family Medicine | Current | Accepting new patients |
| Oconto Hospital & Medical Center Inc | Family Medicine | Current |
Accepting new patients |
| Bellin Memorial Hospital Inc | Family Medicine | Past | Accepting new patients |
Locations
1630 Commanche Ave
Green Bay, WI 54313
Phone (920) 430-4700
744 S Webster Ave
Green Bay, WI 54301
Phone (920) 433-6025
2820 Roosevelt Rd
Marinette, WI 54143
Phone (715) 330-6171
820 Arbutus Ave
Oconto, WI 54153
Phone (920) 835-1100
Interoperability endpoints
- mkroll944364@direct.emplifyhealth.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Family Medicine Physician | 207Q00000X | 81365-20 | WI | Yes |
Addresses
Primary practice location
1630 Commanche Ave
Green Bay, WI 54313-5753
Mailing address
1630 Commanche Ave
Green Bay, WI 54313-5753
Phone (920) 430-4700
NPI Registry JSON
{
"created_epoch": "1617667200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1719964800000",
"number": "1760061865",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1630 COMMANCHE AVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543135753",
"telephone_number": "920-430-4700"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1630 COMMANCHE AVE",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543135753",
"telephone_number": "920-430-4700"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KROLL",
"first_name": "MATTHEW",
"middle_name": "TYLER",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-04-06",
"last_updated": "2024-07-03",
"certification_date": "2024-07-03",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WI",
"license": "81365-20",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
- Brandon Kroeger
- McKenzie Krohn
- Amber Elaine Krokstrom
- Karen M Kroll
- Mark R Kroll
- Rachel D Kroll
- Taylor A Kroll
- Nicholas Kropp
- Lindsey Charles Krouth
- Allison A Krueger
All providers in Green Bay, WI · Family Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 3, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.