MR. RUSSELL TAVERAS (PT) – Physical Therapist, NPI 1669587465
Physical Therapist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
8,787 PHYSICAL THERAPIST IN PRIVATE PRACTICE in NY
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Provider Addresses for MR. RUSSELL TAVERAS (PT)
79, East Main Street, Village of Patchogue, Town of Brookhaven, Suffolk County, New York, 11772, United States
STE I
PATCHOGUE, NY 117723101
Phone: (631) 289-0088
Fax: (631) 289-6177
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.
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: 2012-07-30
PECOS data refreshed: 2026-06-15
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 |
|---|---|---|---|---|
| I20120730000199 | I | Physical Therapist In Private Practice | NY | 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 | 174 | 15 | $0 |
| 97140 | Therapy procedure using manual technique, each 15 minutes | 121 | 11 | $0 |
| 97164 | Re-evaluation for physical therapy, typically 20 minutes | 23 | 11 | $0 |
Insurance plans in this area (ZIP 11772)
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