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KATHLEEN M CROLL
NPI 1376175166
Nurse Practitioner - Family in Toms River, NJ

Active since February 10, 2020PECOS Enrolled
94.95/100
CMS Quality Rating
1868 HOOPER AVE STE 6, TOMS RIVER, NJ 08753(848) 223-7120(732) 349-6919 Get Directions Write a Review

NPPES record last updated: December 7, 2021. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Dec 7, 2021, May 20, 2021, Feb 10, 2020 (3 updates tracked since 2020).

About Kathleen M Croll NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

KATHLEEN M CROLL (NPI 1376175166) is an individual family provider in Toms River, New Jersey, licensed in New Jersey (26NJ01043211) and active in the NPI registry since February 2020. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1376175166
Entity TypeIndividualFemale
Primary Taxonomy363LF0000X
Provider Legal NameKATHLEEN M CROLL
Location Address1868 HOOPER AVE STE 6Toms River, NJ 08753-8175
Mailing Address1868 Hooper Ave Ste 6Toms River, NJ 08753-8175 · (848) 223-7120 · Fax (732) 349-6919
Phone(848) 223-7120
Fax(732) 349-6919
Sole ProprietorYes
Enumeration DateFebruary 10, 2020
Last NPPES UpdateDecember 7, 20213 updates tracked since enumeration
NPPES CertifiedOctober 18, 2021
✔ NPI 1376175166 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNurse Practitioner · FamilyPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363LF0000X
Licenses✔ Licensed in NJ · 26NJ01043211✔ Licensed in NH · 059922-23
1868 HOOPER AVE STE 6, Toms River, NJ 08753
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Oscar Health.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kathleen M Croll is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Kathleen Croll reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Hackensack Meridian Health Medical Group - Primary Care PC
22 mi
Family Medicine
331 NEWMAN SPRINGS RD STE 220
Red Bank, NJ 07701
  • Reassigned Medicare billing, New Jersey enrollment
  • 689 clinicians in this Medicare group
NPI 1336203538 (732) 807-0800

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 9

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
154 services93 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
92 services71 patients
Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit G0439
An annual wellness visit is a yearly appointment with your primary care provider to create or update a personalized prevention plan. This plan helps prevent illness based on your current health and risk factors. It's a subsequent visit, meaning it follows an initial assessment.
30 services30 patients
Hemoglobin a1c level 83036
Hemoglobin A1c (HbA1c) is a test that measures your average blood sugar level over the past 2-3 months. It's used to monitor how well diabetes is being controlled. High levels may indicate that your diabetes treatment plan needs adjustment.
21 services18 patients
Administration of influenza virus vaccine G0008
The administration of the influenza virus vaccine, also known as the flu shot, is a simple procedure to protect against the flu. A healthcare provider injects a small dose of the vaccine into your arm. This stimulates your immune system to produce antibodies, which will help your body fight off the flu if exposed.
14 services14 patients
Influenza vaccine split virus, preservative free 90662
The Influenza Vaccine Split Virus, preservative-free, is a flu shot to protect against the influenza virus. It is made from parts of inactivated flu viruses and doesn't contain preservatives, reducing potential side effects. It helps your body develop immunity to the flu.
13 services13 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 08753 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$94.90 typical visit price
range $61.59 – $185.05
Typical copayment $23.72 (range $15.39 – $46.26)
Most-billed visit code 99203
Established Patient
$107.94 typical visit price
range $20.08 – $150.98
Typical copayment $26.98 (range $5.02 – $37.74)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

94.95/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored through an Alternative Payment Model
Quality87.26
Promoting Interoperability100
Improvement Activities40

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. FREDERICK ACQUAH MD/MBA
Internal Medicine
1868 HOOPER AVE STE 6
TOMS RIVER, NJ 08753
Ocean County (848) 223-7120

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kathleen Croll's NPI number?

The NPI number for Kathleen Croll is 1376175166. It was assigned to this individual provider in the NPPES registry on February 10, 2020.

Where is Kathleen Croll located?

Kathleen Croll practices at 1868 Hooper Ave Ste 6, Toms River, NJ 08753. The listed phone number is (848) 223-7120.

What is Kathleen Croll's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Family, with taxonomy code 363LF0000X.

Is Kathleen Croll enrolled in Medicare?

Yes. Kathleen Croll is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Kathleen Croll's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Kathleen Croll reassigns Medicare benefits to Hackensack Meridian Health Medical Group - Primary Care PC (Red Bank, NJ). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Kathleen Croll's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Kathleen Croll accept?

Health plans from Oscar Health list Kathleen Croll as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kathleen Croll was last updated on December 7, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 4 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.