MR. JEFFREY THOMAS SMITH (OTR/L, CHT) – Occupational Therapist, NPI 1962422915
Occupational Therapist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
490 OCCUPATIONAL THERAPIST IN PRIVATE PRACTICE in IN
Provider Addresses for MR. JEFFREY THOMAS SMITH (OTR/L, CHT)
53880 CARMICHAEL DR
SOUTH BEND, IN 466351567
Phone: (574) 247-9441
Fax: (574) 247-9442
Type: Mailing
PO BOX 19070
GREEN BAY, WI 543079070
Phone: (920) 496-4700
Type: Mailing
1715 DOUSMAN ST
GREEN BAY, WI 543033211
Phone: (920) 496-4700
Type: Location
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.
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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: 2021-04-30
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20210430000783 | I | Occupational Therapist In Private Practice | WI | TBD |
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.
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
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 97112 | Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes | 148 | 26 | $0 |
| 97166 | Evaluation for occupational therapy, typically 45 minutes | 17 | 17 | $0 |
Insurance plans in this area (ZIP 46635)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| P O D I A T R Y | WI | |
| - | WI | |
| - | WI | |
| Family Practice, Sports Medicine | WI | |
| - | OH | |
| Physical Therapist In Private Practice | WI | |
| - | WI | |
| - | WI | |
| Internal Medicine, Hospitalist | WI | |
| - | WI |
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