MRS. KIMBERLY L WALLER (PA-C) – Physician Assistant, NPI 1093782914
Physician Assistant
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
2,876 PHYSICIAN ASSISTANT in OR
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Provider Addresses for MRS. KIMBERLY L WALLER (PA-C)
1701, Northwest Hawthorne Avenue, Grants Pass, Josephine County, Oregon, 97526, United States
GRANTS PASS, OR 975261051
Phone: (541) 471-3455
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: 2006-11-01
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 |
|---|---|---|---|---|
| I20061101000505 | I | Physician Assistant | OR | 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 |
|---|---|---|---|---|
| 80053 | Blood test, comprehensive group of blood chemicals | 33 | 30 | $0 |
| 82044 | Urine microalbumin (protein) analysis | 30 | 27 | $0 |
| 82570 | Creatinine level to test for kidney function or muscle injury | 29 | 27 | $0 |
| 83036 | Hemoglobin a1c level | 28 | 26 | $0 |
Insurance plans in this area (ZIP 97526)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | OR | |
| Nurse Practitioner | OR | |
| Family Practice | OR | |
| Nurse Practitioner | OR | |
| Clinical Social Worker | OR | |
| Internal Medicine | OR | |
| Nurse Practitioner | OR | |
| Nurse Practitioner | OR | |
| Nurse Practitioner | OR | |
| Family Practice | NH |
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