KIMBERLY ANN PETTIT (M.D.) – Dermatology Physician, NPI 1093789299
Dermatology Physician
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Profile Insights
NPPES metrics only — not quality of care.
197 DERMATOLOGY in UT
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Provider Addresses for KIMBERLY ANN PETTIT (M.D.)
PO BOX 27128
SALT LAKE CITY, UT 841270128
Phone: (801) 492-2300
Type: Mailing
North 1100 East, American Fork, Utah County, Utah, 84062, United States
SUITE 301
AMERICAN FORK, UT 840032935
Phone: (801) 492-2300
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 10 Open Payments records for all available years, with a total value of $186.
Total Amount is formed as General ($186) + Research ($0) + Ownership ($0) = $186.
Last reported payment date: 2024-10-24 • Largest payer in this snapshot: Arcutis Biotherapeutics, Inc. ($93).
Total Amount
$186
General + Research + Ownership
Payments
10
Total payment records
General Amount
$186
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-10-24
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| Arcutis Biotherapeutics, Inc. | $93 |
| Galderma Laboratories, L.P. | $63 |
| GENZYME CORPORATION | $30 |
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: 2010-10-15
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 |
|---|---|---|---|---|
| I20101015000860 | I | Dermatology | UT | 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 | 187 | 52 | $0 |
| 99213 | Established patient office or other outpatient visit, 20-29 minutes | 157 | 134 | $0 |
| 17000 | Destruction of precancer skin growth, 1 growth | 105 | 90 | $0 |
| 11102 | Biopsy of related skin growth, first growth | 99 | 90 | $0 |
| 17110 | Destruction of skin growth, 1-14 growths | 89 | 81 | $0 |
Insurance plans in this area (ZIP 84127)
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Provider's Procedures
Group practice members
| Name | Specialty | State |
|---|---|---|
| - | OR | |
| Diagnostic Radiology | UT | |
| Family Practice | UT | |
| H O S P I T A L I S T | UT | |
| O B S T E T R I C S/ G Y N E C O L O G Y | UT | |
| - | UT | |
| - | UT | |
| - | UT | |
| Family Practice | UT | |
| - | UT |
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