CLARK C OTLEY (M.D.) – MOHS-Micrographic Surgery Physician, NPI 1578535506
MOHS-Micrographic Surgery Physician
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Profile Insights
NPPES metrics only — not quality of care.
49 MICROGRAPHIC DERMATOLOGIC SURGERY (MDS) in MN
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Provider Addresses for CLARK C OTLEY (M.D.)
1st Street Southwest, Rochester, Olmsted County, Minnesota, 55903, United States
ROCHESTER, MN 559050001
Phone: (507) 284-2511
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)
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: 2017-12-13
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20100211000282 | I | Micrographic Dermatologic Surgery (Mds) | MN | TBD |
| I20171213002592 | I | Dermatology | FL | 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 |
|---|---|---|---|---|
| 17311 | Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, 1-5 tissue blocks | 228 | 174 | $0 |
| 17312 | Removal and microscopic exam of growth of head, neck, hands, feet, or genitals, each additional stage, 1-5 tissue blocks | 75 | 51 | $0 |
| 12032 | Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm | 63 | 63 | $0 |
| 17003 | Destruction of precancer skin growth, 2-14 growths | 49 | 16 | $0 |
| 12052 | Intermediate repair of wound of face, ears, eyelids, nose, lips, or mouth, 2.6-5.0 cm | 47 | 47 | $0 |
Insurance plans in this area (ZIP 55905)
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Provider's Procedures
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | WA | |
| Psychiatry, Addiction Medicine | MN | |
| - | MN | |
| - | MN | |
| - | MN | |
| - | MN | |
| O P H T H A L M O L O G Y | MN | |
| - | MN | |
| - | MN | |
| - | MN |
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