CRYSTAL KUCUK MACOMB (DO) – Sports Medicine (Family Medicine) Physician, NPI 1881121655
Sports Medicine (Family Medicine) Physician
Main info
Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for CRYSTAL KUCUK MACOMB (DO)
501 W 14th St
Wilmington, DE 198011013
Phone: (302) 733-1000
Type: Location
3650 Joseph Siewick Dr Ste 400
Fairfax, VA 220331715
Phone: (703) 391-2020
Type: Location
Joseph Siewick Drive, Chantilly, Fairfax County, Virginia, 22033, United States
FAIRFAX, VA 220331715
Phone:
Type: Mailing
501, West 14th Street, Midtown Brandywine, Wilmington, New Castle County, Delaware, 19801, United States
WILMINGTON, DE 198011013
Phone: (302) 733-1000
Type: Location
650 JOEL DR
FORT CAMPBELL, KY 422235318
Phone:
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.
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: 2020-07-06
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 |
|---|---|---|---|---|
| I20200706000711 | I | Family Practice | DC | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 19801)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Family Practice | MD | |
| Family Practice | VA | |
| Family Practice | OH | |
| - | VA | |
| Family Practice | VA | |
| - | VA | |
| Family Practice | IL | |
| Family Practice | MD | |
| Internal Medicine | VA | |
| Family Practice | VA |
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