DR. SARA RAE BETTERLY WALLEN – Optometrist, NPI 1316102643
Optometrist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
879 OPTOMETRY in MN
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Provider Addresses for DR. SARA RAE BETTERLY WALLEN
Hague Avenue, Saint Paul, Ramsey County, Minnesota, 55104, United States
SAINT PAUL, MN 551046951
Phone: (651) 210-6202
Type: Mailing
Dakota Development Complex, 2330, Sioux Trail Northwest, Prior Lake, Scott County, Minnesota, 55372, United States
PRIOR LAKE, MN 553729077
Phone: (952) 233-2955
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 9 Open Payments records for all available years, with a total value of $189.
Total Amount is formed as General ($189) + Research ($0) + Ownership ($0) = $189.
Last reported payment date: 2024-05-29 • Largest payer in this snapshot: Johnson & Johnson Vision Care, Inc. ($130).
Total Amount
$189
General + Research + Ownership
Payments
9
Total payment records
General Amount
$189
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-05-29
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Johnson & Johnson Vision Care, Inc. | $130 |
| Alcon Vision LLC | $44 |
| Coltene Whaledent Inc. | $15 |
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: 2025-07-23
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 |
|---|---|---|---|---|
| I20250723000711 | I | Optometry | 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 55104)
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