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MARY K KUKOLICH MD
NPI 1912918111
Medical Genetics - Clinical Genetics (M.D.) in Fort Worth, TX

Active since August 11, 2006PECOS Enrolled
750 8TH AVE STE 200, FORT WORTH, TX 76104(682) 885-2170(817) 335-8277 Get Directions Write a Review

NPPES record last updated: May 17, 2021. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: May 17, 2021, Apr 9, 2021 (2 updates tracked since 2021).

About Mary K Kukolich Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARY K KUKOLICH MD (NPI 1912918111) is an individual clinical genetics (m.d.) provider in Fort Worth, Texas, licensed in Texas (E5817) and active in the NPI registry since August 2006. She is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1912918111
Entity TypeIndividualFemale
Primary Taxonomy207SG0201X
Provider Legal NameMARY K KUKOLICHCredential: MD
Location Address750 8TH AVE STE 200Fort Worth, TX 76104-2500
Mailing AddressPo Box 733784Dallas, TX 75373-3784 · (682) 885-1855 · Fax (682) 885-1396
Phone(682) 885-2170
Fax(817) 335-8277
Sole ProprietorNo
Enumeration DateAugust 11, 2006
Last NPPES UpdateMay 17, 20212 updates tracked since enumeration
NPPES CertifiedMay 17, 2021
✔ NPI 1912918111 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyMedical Genetics · Clinical Genetics (M.D.)Allopathic & Osteopathic Physicians
Taxonomy Code207SG0201X
License✔ Licensed in TX · E5817
Definition
A clinical geneticist demonstrates competence in providing comprehensive diagnostic, management and counseling services for genetic disorders.
Also ListedPediatricsTaxonomy 208000000X · License E5817 (TX)
750 8TH AVE STE 200, Fort Worth, TX 76104
Open in Google Maps ↗

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Baylor Scott and White Health Plan, Imperial Insurance Companies, Inc..Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Mary K Kukolich Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Medicare Billing Reassignment

Medicare enrollment records show Mary Kukolich reassigns Medicare billing to 1 organization. The organization bills Medicare for the services this provider delivers there.

Cook Children's Physician Network
0.1 mi
Developmental - Behavioral Pediatrics
1500 COOPER ST
Fort Worth, TX 76104
  • Reassigned Medicare billing, Texas enrollment
  • Medicare enrollment name: Cook Childrens Physician Network
  • 1,186 clinicians in this Medicare group
NPI 1548230923 (682) 303-9200

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

REBECCA KNOCKEMUS RDLD
Dietitian, Registered
750 8TH AVE STE 200
FORT WORTH, TX 76104
Tarrant County (682) 885-2170
ALEXA SHARON BARBAGALLO
Genetic Counselor, MS
750 8TH AVE STE 200
FORT WORTH, TX 76104
Tarrant County (682) 303-4102
DR. JOANNE NGUYEN M.D.
Medical Genetics (Clinical Genetics (M.D.))
750 8TH AVE STE 200
FORT WORTH, TX 76104
Tarrant County (682) 885-2170
LORI LEANN LLERA CPNP
Nurse Practitioner (Pediatrics)
750 8TH AVE STE 200
FORT WORTH, TX 76104
Tarrant County (682) 885-2170
MS. ALICIA DANIELLE HERNANDEZ MS, CGC
Genetic Counselor, MS
750 8TH AVE STE 200
FORT WORTH, TX 76104
Tarrant County (682) 885-5942
TINA GRACE BARBARO DIEBER MD
Medical Genetics (Clinical Genetics (M.D.))
750 8TH AVE STE 200
FORT WORTH, TX 76104
Tarrant County (682) 885-2170
MRS. AMY CHRISTINE THOMAS M.S., C.G.C.
Genetic Counselor, MS
750 8TH AVE STE 200
FORT WORTH, TX 76104
Tarrant County (682) 885-2170
DR. ALEXANDRA GARZA FLORES M.D.
Medical Genetics (Clinical Genetics (M.D.))
750 8TH AVE STE 200
FORT WORTH, TX 76104
Tarrant County (682) 885-2170

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mary Kukolich's NPI number?

The NPI number for Mary Kukolich is 1912918111. It was assigned to this individual provider in the NPPES registry on August 11, 2006.

Where is Mary Kukolich located?

Mary Kukolich practices at 750 8th Ave Ste 200, Fort Worth, TX 76104. The listed phone number is (682) 885-2170.

What is Mary Kukolich's specialty?

The primary specialty registered for this NPI is Medical Genetics, specializing in Clinical Genetics (M.D.), with taxonomy code 207SG0201X.

Is Mary Kukolich enrolled in Medicare?

Yes. Mary Kukolich is registered in the Medicare PECOS enrollment system.

Which organization bills Medicare for Mary Kukolich's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Mary Kukolich reassigns Medicare benefits to Cook Children's Physician Network (Fort Worth, TX). The reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Mary Kukolich's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Mary Kukolich accept?

Health plans from Baylor Scott and White Health Plan and Imperial Insurance Companies, Inc. list Mary Kukolich as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Mary Kukolich was last updated on May 17, 2021. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 5 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.