KENNETH D POLIVY (M.D.) – Orthopaedic Surgery Physician, NPI 1194794115
Orthopaedic Surgery Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
948 ORTHOPEDIC SURGERY in MA
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Provider Addresses for KENNETH D POLIVY (M.D.)
Visitor Parking, 2000, Washington Street, Newton Lower Falls, Newton, Middlesex County, Massachusetts, 02462, United States
SUITE 341
NEWTON, MA 024621650
Phone: (617) 964-0024
Fax: (617) 964-6374
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)
CMS reports 1 Open Payments records for all available years, with a total value of $48.
Total Amount is formed as General ($48) + Research ($0) + Ownership ($0) = $48.
Last reported payment date: 2023-03-16 • Largest payer in this snapshot: Biocomposites Inc ($48).
Total Amount
$48
General + Research + Ownership
Payments
1
Total payment records
General Amount
$48
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-03-16
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Biocomposites Inc | $48 |
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: 2005-03-24
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 |
|---|---|---|---|---|
| I20050324000134 | I | Orthopedic Surgery | MA | 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 |
|---|---|---|---|---|
| J1030 | Injection, methylprednisolone acetate, 40 mg | 884 | 184 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 372 | 236 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 308 | 270 | $0 |
| 72114 | X-ray lower and sacral spine, minimum of 6 views | 266 | 131 | $0 |
| 64483 | Injection of anesthetic and/or steroid drug into sacral spine nerve root using imaging guidance, single level | 202 | 125 | $0 |
Insurance plans in this area (ZIP 02462)
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Provider's Procedures
Group practice members
| Name | Specialty | State |
|---|---|---|
| Physician Assistant | MA | |
| - | MA | |
| Physician Assistant | WI | |
| Occupational Therapist In Private Practice | MA | |
| Orthopedic Surgery | MA | |
| Physician Assistant | MA | |
| Physician Assistant | MA | |
| Hand Surgery, Orthopedic Surgery | MA | |
| Orthopedic Surgery | MA | |
| Orthopedic Surgery | MA |
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