Jesse Kroll

Primary specialty

Physical TherapistTaxonomy code 225100000X

License

5501019617 Issued in MI

Practice address

1513 N McEwan St
Clare, MI 48617-1162

Phone

(989) 424-6088

NPI assigned

Jul 8, 2020

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

Medicare fee-for-service enrollment

Enrolled in MI

Enrollment records 1

Specialty

Physical Therapist in Private Practice

Education

University of Wisconsin School of Medicine, 2020

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Sport Summit Physical Therapy LLCGroup PAC ID 3577995737, 5 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

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.

• Sport Summit Physical Therapy LLC

  • Physical Therapy Clinic/Center
  • Clare, MI
  • NPI 1861047847

  Physical Therapist

  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1594166400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594166400000",
    "number": "1891313672",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1513 N MCEWAN ST",
            "city": "CLARE",
            "state": "MI",
            "postal_code": "486171162",
            "telephone_number": "989-424-6088"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1513 N MCEWAN ST",
            "city": "CLARE",
            "state": "MI",
            "postal_code": "486171162",
            "telephone_number": "989-424-6088"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KROLL",
        "first_name": "JESSE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-07-08",
        "last_updated": "2020-07-08",
        "certification_date": "2020-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225100000X",
            "taxonomy_group": "",
            "desc": "Physical Therapist",
            "state": "MI",
            "license": "5501019617",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nabil Ahmad Khan, M.D.
• Kimberly Kidd, LLMSW
• David A. Killingbeck, PA-C
• Sondra Lynn Kissell
• Brittany Anette Klein, LPTA
• Cherie Lalone, LPC
• Nicholas Latuszek, DPT
• Daniel Leppek, PT
• Brianna Rose Lybeer, MA CCC-SLP
• Magnum Health and Rehab of Clare LLC

• Physical Therapist in Clare, MI
• Providers in Clare, MI by specialty
• Physical Therapist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2020; 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.