MRS. AUTUMN LYNN BERTHOLDI (PA-C) – Dermatology Physician, NPI 1013944024
Dermatology Physician
Main info
Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
1,853 PHYSICIAN ASSISTANT in MO
Provider Addresses for MRS. AUTUMN LYNN BERTHOLDI (PA-C)
331 HOSPITAL DR STE C
LEBANON, MO 655369251
Phone: (417) 334-7200
Fax: (417) 334-7299
Type: Location
590 BIRCH RD STE 2C
HOLLISTER, MO 656729607
Phone: (417) 815-6737
Fax: (417) 690-3862
Type: Location
1240 E INDEPENDENCE ST STE 100
SPRINGFIELD, MO 658044201
Phone: (417) 900-3407
Fax: (417) 889-0476
Type: Location
109 PINEHURST DR
BRANSON, MO 656162796
Phone: (417) 888-0858
Fax: (417) 889-0476
Type: Location
1240 E INDEPENDENCE ST STE 200
SPRINGFIELD, MO 658044201
Phone: (417) 900-3407
Fax: (417) 889-0476
Type: Location
2200 E CLEVELAND ST
MONETT, MO 657086149
Phone: (417) 900-3407
Fax: (417) 889-0476
Type: Location
3850 S NATIONAL AVE STE 705
SPRINGFIELD, MO 658075239
Phone: (417) 888-0858
Fax: (417) 889-0476
Type: Mailing
801 YORK ST
MANITOWOC, WI 542204630
Phone: (920) 663-9008
Fax: (920) 684-1439
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 56 Open Payments records for all available years, with a total value of $1,395.
Total Amount is formed as General ($1,395) + Research ($0) + Ownership ($0) = $1,395.
Last reported payment date: 2024-12-23 • Largest payer in this snapshot: Janssen Biotech, Inc. ($335).
Total Amount
$1,395
General + Research + Ownership
Payments
56
Total payment records
General Amount
$1,395
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-23
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Janssen Biotech, Inc. | $335 |
| ABBVIE INC. | $214 |
| E.R. Squibb & Sons, L.L.C. | $185 |
| Incyte Corporation | $153 |
| Lilly USA, LLC | $102 |
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: 2006-06-27
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 |
|---|---|---|---|---|
| I20060627000313 | I | Physician Assistant | MO | 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 |
|---|---|---|---|---|
| 17003 | Destruction of precancer skin growth, 2-14 growths | 85 | 16 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 23 | 23 | $0 |
| 17000 | Destruction of precancer skin growth, 1 growth | 19 | 19 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 12 | 12 | $0 |
| 11102 | Biopsy of related skin growth, first growth | 11 | 11 | $0 |
Insurance plans in this area (ZIP 65536)
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Provider's Procedures
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | WI | |
| Physician Assistant | VA | |
| - | VA | |
| D E R M A T O L O G Y | TX | |
| - | WI | |
| D E R M A T O L O G Y | AL | |
| D E R M A T O L O G Y | WI | |
| - | WI | |
| Physician Assistant | NY | |
| D E R M A T O L O G Y | WA |
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