RENAT KUDYAKOV – Nurse Practitioner, NPI 1578912325
Nurse Practitioner
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Profile Insights
NPPES metrics only — not quality of care.
22,204 NURSE PRACTITIONER in TX
Provider Addresses for RENAT KUDYAKOV
7777 Forest Ln Ste B446
Dallas, TX 752305647
Phone: (972) 566-8822
Fax: (972) 566-8861
Type: Location
Forest Lane, Lake Highlands, Bethard, Garland, Dallas County, Texas, 75243, United States
DALLAS, TX 752302571
Phone: (972) 566-8822
Fax: (972) 566-8861
Type: Mailing
7777 FOREST LN STE B446
DALLAS, TX 752305647
Phone: (972) 566-8822
Fax: (972) 566-8861
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: 2019-12-30
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 |
|---|---|---|---|---|
| I20170919000159 | I | Nurse Practitioner | NY | TBD |
| I20191230002341 | I | Nurse Practitioner | TX | 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 75230)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| General Surgery | NC | |
| Nurse Practitioner | TX | |
| Gastroenterology, Internal Medicine | LA | |
| Internal Medicine | PA | |
| General Surgery, Gastroenterology, Internal Medicine | SD | |
| General Surgery, Hematopoietic Cell Transplantation And Cellular Therapy | TX | |
| Physician Assistant | TX | |
| General Surgery | TX | |
| Physician Assistant | TX | |
| General Surgery | TX |
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