KYLE FETTEROLF (PA) – Physician Assistant, NPI 1477529501
Physician Assistant
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Profile Insights
NPPES metrics only — not quality of care.
9,691 PHYSICIAN ASSISTANT in PA
Provider Addresses for KYLE FETTEROLF (PA)
575 N River St
Wilkes Barre, PA 187640999
Phone: (570) 270-9192
Type: Location
334 Main St
Dickson City, PA 185191668
Phone: (888) 952-6772
Type: Location
677 Kidder St Ste D
Wilkes Barre Township, PA 187026914
Phone: (570) 825-2046
Type: Location
PO BOX 349
DUNMORE, PA 185120349
Phone:
Type: Mailing
423 3RD AVE STE B
KINGSTON, PA 187045809
Phone: (570) 288-3601
Fax: (570) 288-1726
Type: Mailing
Wilkes-Barre General Hospital, 575, North River Street, North End, Wilkes-Barre, Luzerne County, Pennsylvania, 18764, United States
WILKES BARRE, PA 187640999
Phone: (570) 270-9192
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 12 Open Payments records for all available years, with a total value of $834.
Total Amount is formed as General ($834) + Research ($0) + Ownership ($0) = $834.
Last reported payment date: 2024-09-17 • Largest payer in this snapshot: AstraZeneca Pharmaceuticals LP ($278).
Total Amount
$834
General + Research + Ownership
Payments
12
Total payment records
General Amount
$834
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-09-17
Latest reported date
Top Companies
Largest payers in this snapshot
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: 2007-01-18
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 |
|---|---|---|---|---|
| I20070118000165 | I | Physician Assistant | PA | 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 |
|---|---|---|---|---|
| 99285 | Emergency department visit with high level of medical decision making | 227 | 222 | $0 |
| 99284 | Emergency department visit with moderate level of medical decision making | 107 | 105 | $0 |
| 93010 | Routine electrocardiogram (ecg) using at least 12 leads with interpretation and report only | 75 | 71 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 28 | 27 | $0 |
| 87811 | Detection test by immunoassay with direct visual observation for severe acute respiratory syndrome coronavirus 2 (covid-19) | 17 | 17 | $0 |
Insurance plans in this area (ZIP 18764)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Nurse Practitioner | PA | |
| General Surgery | PA | |
| Family Practice | PA | |
| Physician Assistant | PA | |
| - | PA | |
| - | PA | |
| Physician Assistant | PA | |
| Physician Assistant | PA | |
| N E U R O L O G Y | PA | |
| - | PA |
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