MARY K KUKOLICH (MD) – Clinical Genetics (M.D.) Physician, NPI 1912918111
Clinical Genetics (M.D.) Physician
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Doctor Profile
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Profile Insights
NPPES metrics only — not quality of care.
43 MEDICAL GENETICS AND GENOMICS in TX
Provider Addresses for MARY K KUKOLICH (MD)
PO BOX 733784
DALLAS, TX 753733784
Phone: (682) 885-1855
Fax: (682) 885-1396
Type: Mailing
750 8TH AVE STE 200
FORT WORTH, TX 761042500
Phone: (682) 885-2170
Fax: (817) 335-8277
Type: Location
FT, R 42, Zieglöde, Frauenzell, Wiesent, Wörth an der Donau (VGem), Landkreis Regensburg, Bavaria, 93109, Germany
FORT WORTH, TX 761990371
Phone: (682) 885-1855
Fax: (682) 885-7347
Type: Mailing
Child Study Center, 1300, West Lancaster Avenue, Fort Worth, Tarrant County, Texas, 76102, United States
STE 204
FORT WORTH, TX 761023410
Phone: (682) 885-2170
Fax: (817) 335-8277
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 2 Open Payments records for all available years, with a total value of $45.
Total Amount is formed as General ($45) + Research ($0) + Ownership ($0) = $45.
Last reported payment date: 2024-07-11 • Largest payer in this snapshot: ACADIA Pharmaceuticals Inc ($24).
Total Amount
$45
General + Research + Ownership
Payments
2
Total payment records
General Amount
$45
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-07-11
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| ACADIA Pharmaceuticals Inc | $24 |
| Ultragenyx Pharmaceutical Inc. | $21 |
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: 2004-04-21
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 |
|---|---|---|---|---|
| I20040421001600 | I | Pediatric Medicine | 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 75373)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Pediatric Medicine, Cardiac Electrophysiology | TX | |
| - | OK | |
| - | TX | |
| H O S P I T A L I S T | VA | |
| - | TX | |
| - | TX | |
| - | TX | |
| Pulmonary Disease, Pediatric Medicine | TX | |
| - | TX | |
| Certified Registered Nurse Anesthetist (Crna) | TX |
Reviews
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