JENICA M ROSE-STINE (DO) – Pediatrics Physician, NPI 1174735872
Pediatrics Physician
Main info
Contacts
Profile Insights
NPPES metrics only — not quality of care.
Provider Addresses for JENICA M ROSE-STINE (DO)
PO BOX 733784
DALLAS, TX 753733784
Phone: (682) 885-1855
Fax: (682) 885-1396
Type: Mailing
136 EL CHICO TRL STE 102
WILLOW PARK, TX 760878864
Phone: (817) 441-5412
Fax: (817) 441-9354
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
3200, Riverfront Drive, Fort Worth, Tarrant County, Texas, 76107, United States
STE 103
FORT WORTH, TX 761076570
Phone: (817) 336-3800
Fax: (817) 335-9454
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 1 Open Payments records for all available years, with a total value of $20.
Total Amount is formed as General ($20) + Research ($0) + Ownership ($0) = $20.
Last reported payment date: 2023-08-18 • Largest payer in this snapshot: PFIZER INC. ($20).
Total Amount
$20
General + Research + Ownership
Payments
1
Total payment records
General Amount
$20
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2023-08-18
Latest reported date
Top Companies
Largest payers in this snapshot
| Company | Amount |
|---|---|
| PFIZER INC. | $20 |
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: 2008-08-08
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 |
|---|---|---|---|---|
| I20080808000308 | 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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Reviews
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