MARY KIM TADDA – Physical Therapist, NPI 1174157564

MARY KIM TADDA is a healthcare provider. based in Evergreen, Colorado. specializing in PHYSICAL THERAPIST IN PRIVATE PRACTICE. They hold a License No. 16846 (CO). The NPI Number for MARY KIM TADDA is 1174157564

Main info

Female
7 Years Of Experience
Accepts Medicare Assignment
Name
MARY KIM TADDA
NPI
1174157564
Phone
Not provided
Address
30940 STAGECOACH BLVD # 110
Enumeration Date
25 February 2020
Last Update Date
25 February 2020

Doctor Profile

Medical School Name
OTHER
Secondary Phone
3036745522
Graduation Year
2019 (7 years ago)
PAC ID
8123456134
Group Practice PAC ID
1759318454
Professional Enrollment ID
I20200325000011
Address ID
CO804399778EV32003TRLX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience36
Completeness75
Years active:6State licenses:1Digital endpointsOther names

2,988 PHYSICAL THERAPIST IN PRIVATE PRACTICE in CO

Provider Addresses for MARY KIM TADDA

  • 30940 STAGECOACH BLVD # 110

    EVERGREEN, CO 804397984

    Phone:

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2020-03-25

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20200325000011IPhysical Therapist In Private PracticeCOTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
97110Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes65859$0
97140Therapy procedure using manual technique, each 15 minutes57849$0
97112Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes14520$0
97162Evaluation for physical therapy, typically 30 minutes3736$0
View full utilization report →

Insurance plans in this area (ZIP 80439)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1759318454View full group profile
NameSpecialtyState
Physical Therapist In Private PracticeCO
-IL
Physical Therapist In Private PracticeCO
-KS
Physical Therapist In Private PracticeCO

Reviews

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Frequently asked questions

Does MARY KIM TADDA share an NPI with anyone else?
NPI numbers are unique to each provider or organization — MARY KIM TADDA uses 1174157564.
Can I rely on MARY KIM TADDA being an active provider?
As of the registry snapshot, MARY KIM TADDA is marked active.
What taxonomy line describes MARY KIM TADDA?
For research purposes, treat MARY KIM TADDA as Physical Therapist in this dataset. Clinical services aligned with this taxonomy classification.
Where should I expect MARY KIM TADDA on a map?
Expect Evergreen, Colorado as a primary anchor for MARY KIM TADDA unless the record lists multiple sites.
Is the information about MARY KIM TADDA up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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