Kristine Eubanks, M.A. CCC-A – Audiologist

Key facts

NPI: 1235345299
Entity type: Individual (NPI type 1)
Primary specialty: Audiologist 231H00000X
License: 147-000685 (IL)
Practice address: 2201 Glenwood Ave
Joliet, IL 60435-5574
Phone: (815) 725-1191
Fax: (815) 725-2048
NPI assigned: May 15, 2007
Sex: Female
Sole proprietor: No

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

ENT Surgical Consultants, LTD Otolaryngology Physician · Joliet, IL · NPI 1881620177

Medicare reassignment Care Compare group NPD IL

Medicare Care Compare profile

Specialty: Qualified Audiologist
Education: Other, 1993
Medicare assignment: Accepts the Medicare-approved amount as payment in full
Group practices: ENT Surgical Consultants LTD (16 clinicians)

Practice addresses (Care Compare)

2201 Gleenwood Ave
Joliet, IL 60435-5574
Phone (815) 725-1191

Medicare participation

Medicare fee-for-service enrollment: Enrolled in IL

Medicare enrollment records

Enrollment ID	State	Provider type	PAC ID	Details
I20081110000787	IL	Practitioner - Qualified Audiologist	0446319123	Reassigns benefits to 1 organization

National Provider Directory

Medicare enrollment (NPD): Yes
Credentials: Master of Arts

State licenses

License	State	Type	Specialty
147-000685	IL	MD	Audiologist

Practice roles

Organization	Specialty	Status	New patients
ENT Surgical Consultants, LTD		Current since Oct 1, 2008	Accepting new patients

Locations

2201 Glenwood Ave
Joliet, IL 60435
Phone (815) 725-1191

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Audiologist	231H00000X	147-000685	IL	Yes

Addresses

Primary practice location

2201 Glenwood Ave
Joliet, IL 60435-5574

Mailing address

2201 Glenwood Ave
Joliet, IL 60435-5574
Phone (815) 725-1191

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 23, 2008.

{
    "created_epoch": "1179187200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1222128000000",
    "number": "1235345299",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 GLENWOOD AVE",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604355574",
            "telephone_number": "815-725-1191",
            "fax_number": "815-725-2048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 GLENWOOD AVE",
            "city": "JOLIET",
            "state": "IL",
            "postal_code": "604355574",
            "telephone_number": "815-725-1191",
            "fax_number": "815-725-2048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EUBANKS",
        "first_name": "KRISTINE",
        "credential": "M.A. CCC-A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-15",
        "last_updated": "2008-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "IL",
            "license": "147-000685",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Joliet, IL

All providers in Joliet, IL · Audiologist in Illinois

Sources for this page

NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 23, 2008. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.