DR. RUSSELL WILLIAM JR. KINKADE (PSYD) – Clinical Psychologist, NPI 1033295571
Clinical Psychologist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
667 CLINICAL PSYCHOLOGIST in WI
Provider Addresses for DR. RUSSELL WILLIAM JR. KINKADE (PSYD)
131 E Wisconsin Ave Ste 101
Pewaukee, WI 530723400
Phone: (262) 989-5228
Type: Location
S55W29307, Holiday Point Drive, Saylesville, Genesee, Town of Genesee, Waukesha County, Wisconsin, 53189, United States
WAUKESHA, WI 531899026
Phone: (262) 989-5228
Type: Mailing
Mike and Angelo's, 6214, Washington Avenue, Western Village, Mount Pleasant, Racine County, Wisconsin, 53177, United States
SUITE C 10
RACINE, WI 53406
Phone: (262) 989-5228
Type: Location
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: 2015-08-24
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 |
|---|---|---|---|---|
| I20150824001097 | I | Clinical Psychologist | WI | 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 53072)
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