KELLY J WALWORTH (PAC) – Medical Physician Assistant, NPI 1376526756
Medical Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
1,797 PHYSICIAN ASSISTANT in OK
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Provider Addresses for KELLY J WALWORTH (PAC)
DEPT 96-0317
OKLAHOMA CITY, OK 731960317
Phone: (405) 521-1969
Fax: (405) 521-1979
Type: Mailing
North MacArthur Boulevard, Oklahoma City, Oklahoma County, Oklahoma, 73132, United States
OKLAHOMA CITY, OK 731423017
Phone: (405) 721-5555
Fax: (405) 470-7093
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 282 Open Payments records for all available years, with a total value of $6,735.
Total Amount is formed as General ($6,735) + Research ($0) + Ownership ($0) = $6,735.
Last reported payment date: 2024-12-17 • Largest payer in this snapshot: ABBVIE INC. ($1,088).
Total Amount
$6,735
General + Research + Ownership
Payments
282
Total payment records
General Amount
$6,735
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-12-17
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ABBVIE INC. | $1,088 |
| Lilly USA, LLC | $671 |
| E.R. Squibb & Sons, L.L.C. | $668 |
| Novartis Pharmaceuticals Corporation | $323 |
| Arcutis Biotherapeutics, Inc. | $321 |
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: 2005-07-22
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 |
|---|---|---|---|---|
| I20050722000737 | I | Physician Assistant | OK | 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 | 1,069 | 171 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 593 | 412 | $0 |
| 17000 | Destruction of precancer skin growth, 1 growth | 319 | 217 | $0 |
| 17110 | Destruction of skin growth, 1-14 growths | 303 | 226 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 207 | 152 | $0 |
Insurance plans in this area (ZIP 73196)
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Provider's Procedures
| Specialty | Practice State | HCPCS Code | Description | Service Count | Beneficiary Count |
|---|---|---|---|---|---|
| PHYSICIAN ASSISTANT | OK | 17003 | Destruction of 2-14 skin growths | 1346 | 197 |
Group practice members
| Name | Specialty | State |
|---|---|---|
| D E R M A T O L O G Y | OK | |
| D E R M A T O L O G Y | OK | |
| Physician Assistant | OK |
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