KIM A MALETTA SHIBLEY (MD) – Obstetrics & Gynecology Physician, NPI 1184685042
Obstetrics & Gynecology Physician
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Profile Insights
NPPES metrics only — not quality of care.
822 OBSTETRICS/GYNECOLOGY in MN
Provider Addresses for KIM A MALETTA SHIBLEY (MD)
560 S MAPLE ST STE 130
WACONIA, MN 553871753
Phone:
Type: Mailing
Southdale Medical Building, 6525, France Avenue South, Southdale, Edina, Hennepin County, Minnesota, 55435, United States
PAUL LARSON OB GYN CLINIC STE 100
EDINA, MN 554353624
Phone: (952) 927-4021
Fax: (952) 285-6183
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.
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: 2011-10-18
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 |
|---|---|---|---|---|
| I20111018000803 | I | Obstetrics/Gynecology | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 55387)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | MN | |
| Internal Medicine | MN | |
| Family Practice | MN | |
| - | MN | |
| - | MN | |
| Physician Assistant | MN | |
| Diagnostic Radiology | MN | |
| Marriage And Family Therapist | MN | |
| Physician Assistant | MN | |
| Nurse Practitioner | MN |
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