DR. KEVIN KUKOLECK (PSYD) – Clinical Psychologist, NPI 1295821171
Clinical Psychologist
Main info
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for DR. KEVIN KUKOLECK (PSYD)
Prestige Lane, Mobil Country Club, Rancho Cordova, Sacramento County, California, 95670, United States
RANCHO CORDOVA, CA 956704317
Phone: (773) 573-5393
Type: Mailing
4210 MAPLECREST AVE
PARMA, OH 441343524
Phone: (773) 573-5393
Type: Mailing
3591 RESERVE COMMONS DR STE 301
MEDINA, OH 442565334
Phone: (330) 764-7916
Type: Location
101 BODIN CIR
TRAVIS AFB, CA 945351809
Phone: (707) 423-5174
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
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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: 2021-10-19
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 3 Medicare enrollment records; no due dates published yet.
Enrollment records
3
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 |
|---|---|---|---|---|
| I20060125000885 | I | Clinical Psychologist | IL | TBD |
| I20190829002100 | I | Clinical Psychologist | CA | TBD |
| I20211019002193 | I | Clinical Psychologist | OH | 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 |
|---|---|---|---|---|
| 90837 | Psychotherapy, 1 hour | 141 | 32 | $0 |
| 90834 | Psychotherapy, 45 minutes | 40 | 18 | $0 |
| 90791 | Psychiatric diagnostic evaluation | 19 | 19 | $0 |
Insurance plans in this area (ZIP 95670)
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