ANDREW LISITSKY – Physical Therapist, NPI 1104887587
Physical Therapist
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for ANDREW LISITSKY
11800 NE 128th St
STE. 400
Kirkland, WA 980347208
Phone: (425) 820-0869
Fax: (425) 820-1745
Type: Location
603 Division St
North Tonawanda, NY 141204464
Phone: (716) 693-0556
Fax: (866) 907-6157
Type: Location
17885 NE EVERGREEN PARKWAY
STE 220
BEAVERTON, OR 97006
Phone: (503) 571-3366
Type: Location
603, Division Street, North Tonawanda, Niagara County, New York, 14120, United States
NORTH TONAWANDA, NY 141204464
Phone: (716) 693-0556
Fax: (866) 907-6157
Type: Mailing
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.
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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: 2024-12-19
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20041103000628 | I | Physical Therapist In Private Practice | WA | TBD |
| I20241219002652 | I | Physical Therapist In Private Practice | 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 |
|---|---|---|---|---|
| 97140 | Therapy procedure using manual technique, each 15 minutes | 621 | 49 | $0 |
| 97112 | Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes | 535 | 46 | $0 |
| 97110 | Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes | 316 | 41 | $0 |
| 97530 | Therapy procedure using functional activities | 108 | 23 | $0 |
| 97162 | Evaluation for physical therapy, typically 30 minutes | 40 | 31 | $0 |
Insurance plans in this area (ZIP 98034)
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