KIM M WATERBURY (MS, OTRL, CHT) – Occupational Therapist, NPI 1023215720
Occupational Therapist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
603 OCCUPATIONAL THERAPIST IN PRIVATE PRACTICE in MN
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Provider Addresses for KIM M WATERBURY (MS, OTRL, CHT)
Tria Orthopedic Center, 8100, Northland Drive, Bloomington, Hennepin County, Minnesota, 55435, United States
BLOOMINGTON, MN 554314800
Phone: (952) 831-8742
Type: Location
2532, Eagle Valley Drive, Eagle Valley, Woodbury, Washington County, Minnesota, 55129, United States
WOODBURY, MN 551294206
Phone:
Type: Mailing
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: 2006-01-25
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
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20060125000630 | I | Occupational Therapist In Private Practice | MN | 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 |
|---|---|---|---|---|
| 97110 | Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | 71 | 18 | $0 |
| 97165 | Evaluation for occupational therapy, typically 30 minutes | 16 | 16 | $0 |
| 97535 | Training for self-care or home management, each 15 minutes | 15 | 12 | $0 |
Insurance plans in this area (ZIP 55431)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| OCCUPATIONAL THERAPY | MN | 97140 | Manual (physical) therapy techniques to 1 or more regions, each 15 minutes | 62 | 18 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| Physical Therapist In Private Practice | MN | |
| - | MN | |
| Physical Medicine And Rehabilitation | MN | |
| Orthopedic Surgery | MN | |
| - | MN | |
| - | MN | |
| Physical Therapist In Private Practice | MN | |
| - | MN | |
| - | MN | |
| - | MN |
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