NPIMap

Individual provider Active NPI

Kimberly Diane Blankshain, MD

  • Neuro-ophthalmology Physician
  • Wheaton, IL
National Provider Identifier
1801328125
Registry record updated Aug 21, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neuro-ophthalmology PhysicianTaxonomy code 207WX0109X
License
036155745 Issued in IL
Practice address
2015 N Main St
Wheaton, IL 60187-3190
Phone
(630) 668-8250
Fax
(630) 668-8916
NPI assigned
Mar 28, 2017
Last updated
Aug 21, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 21, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X 036155745 IL
Neuro-ophthalmology Physician 207WX0109X 036155745 IL Primary

Addresses

Primary practice location

2015 N Main St
Wheaton, IL 60187-3190

Mailing address

2015 N Main St
Wheaton, IL 60187-3190
Phone (630) 668-8250

Other practice location 1

1855 W Taylor St
Chicago, IL 60612-7242
Phone (312) 413-3593

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210811004313 IL Practitioner - Ophthalmology 6305195504 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Wheaton Eye Clinic LTDGroup PAC ID 2860475944, 44 clinicians

Practice addresses (Care Compare)

2015 N Main St
Wheaton, IL 60187-3152
Phone (630) 668-8250

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
95.63 of 100Reported as apm
Quality
88.47
Promoting interoperability
100
Improvement activities
40

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery196

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Wheaton Eye Clinic LTD Ophthalmology CurrentSince Aug 22, 2022 Accepting new patients
Wheaton Eye Clinic LTD Ophthalmology CurrentSince Aug 22, 2022 Accepting new patients
Wheaton Eye Clinic LTD Ophthalmology Past Accepting new patients

Locations

908 N Elm St
Ste 115
Hinsdale, IL 60521
Phone (630) 321-9429

604 Raymond Dr
Naperville, IL 60563
Phone (630) 668-8250

12426 S Van Dyke Rd
Plainfield, IL 60585
Phone (630) 668-8250

2015 N Main St
Wheaton, IL 60187
Phone (630) 665-3690

Organizations & group practices 3

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

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1490659200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1724198400000",
    "number": "1801328125",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2015 N MAIN ST",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601873190",
            "telephone_number": "630-668-8250",
            "fax_number": "630-668-8916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2015 N MAIN ST",
            "city": "WHEATON",
            "state": "IL",
            "postal_code": "601873190",
            "telephone_number": "630-668-8250",
            "fax_number": "630-668-8916"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1855 W Taylor St",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606127242",
            "country_code": "US",
            "telephone_number": "312-413-3593",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLANKSHAIN",
        "first_name": "KIMBERLY",
        "middle_name": "DIANE",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2017-03-28",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "IL",
            "license": "036155745",
            "primary": false
        },
        {
            "code": "207WX0109X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Neuro-ophthalmology",
            "state": "IL",
            "license": "036155745",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Wheaton, IL

Sources for this page

Verify at the official NPI Registry.