NPIMap

Individual provider Active NPI

Kristian Michael Koller, D.O.

  • Hematology & Oncology Physician
  • Traverse City, MI
National Provider Identifier
1760793368
Registry record updated Dec 21, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
License
5101018711 Issued in MI
Practice address
217 S Madison Street
Traverse City, MI 49684
Phone
(231) 392-8400
Fax
(231) 935-7888
NPI assigned
Jun 29, 2010
Last updated
Dec 21, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2020

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X 5101018711 MI Primary

Addresses

Primary practice location

217 S Madison Street
Traverse City, MI 49684

Mailing address

2513 Momentum PL
Chicago, IL 60689-5325
Phone (231) 935-6080

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address kristian.koller@mhc.direct.varian.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160816000100 MI Practitioner - Hematology/OncologyPractitioner - Internal Medicine 6305130238 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Hematology/OncologyAlso: Internal Medicine
Education
Michigan State University College of Osteopathic Medicine, 2010
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Munson Medical CenterGroup PAC ID 3072426287, 377 clinicians
Munson Healthcare CadillacGroup PAC ID 6305161514, 104 clinicians

Practice addresses (Care Compare)

1105 6TH St
Traverse City, MI 49684-2345
Phone (231) 922-9000

400 Hobart St
Cadillac, MI 49601-2331
Phone (231) 876-7476

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Osteopathy

Practice roles

OrganizationSpecialtyStatusNew patients
Munson Medical Center Current Accepting new patients
Munson Medical Center Internal Medicine CurrentSince Aug 1, 2016 Accepting new patients
Munson Healthcare Cadillac Current Accepting new patients
Munson Healthcare Manistee Hospital CurrentSince Sep 1, 2016 Accepting new patients
Munson Healthcare Cadillac Internal Medicine CurrentSince Aug 1, 2016 Accepting new patients
Munson Healthcare Cadillac CurrentSince Aug 1, 2016 Accepting new patients
Munson Healthcare Manistee Hospital CurrentSince Sep 1, 2016 Accepting new patients
Munson Medical Center CurrentSince Aug 1, 2016 Accepting new patients
Munson Healthcare Cadillac Past Accepting new patients

Locations

2513 Momentum Pl
Chicago, IL 60689
Phone (231) 935-8031

3782 Momentum Pl
Chicago, IL 60689

400 Hobart St
Cadillac, MI 49601
Phone (231) 876-7200

1293 E Parkdale Ave
Manistee, MI 49660
Phone (231) 398-1735

1465 E Parkdale Ave
Manistee, MI 49660
Phone (231) 398-1000

1105 Sixth St
Traverse City, MI 49684
Phone (231) 922-9000

1110 Sixth St
Traverse City, MI 49684
Phone (231) 392-8400

1400 Medical Campus Dr
Traverse City, MI 49684
Phone (231) 935-8000

Interoperability endpoints

  • Direct secure messaging: kristian.koller@mhc.direct.varian.com

Organizations & group practices 9

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 6

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1277769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1608508800000",
    "number": "1760793368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2513 MOMENTUM PL",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606895325",
            "telephone_number": "231-935-6080",
            "fax_number": "231-935-6081"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "217 S MADISON STREET",
            "city": "TRAVERSE CITY",
            "state": "MI",
            "postal_code": "49684",
            "telephone_number": "231-392-8400",
            "fax_number": "231-935-7888"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KOLLER",
        "first_name": "KRISTIAN",
        "middle_name": "MICHAEL",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-29",
        "last_updated": "2020-12-21",
        "certification_date": "2020-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": "MI",
            "license": "5101018711",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kristian.koller@mhc.direct.varian.com",
            "affiliation": "N",
            "address_1": "217 S Madison Street",
            "city": "Traverse City",
            "state": "MI",
            "country_code": "US",
            "postal_code": "49684",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Traverse City, MI

Sources for this page

Verify at the official NPI Registry.