Sandra Blank

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149005374 Issued in IL

Practice address

1 The Court of Harborside
Northbrook, IL 60062-3228

Phone

(847) 757-5011

NPI assigned

Nov 4, 2012

Last updated

Nov 4, 2012By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 1988

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

The Josselyn Center NFPGroup PAC ID 0840289740, 86 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• The Josselyn Center NFP

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Northbrook, IL
  • NPI 1073548640
  Medicare reassignment Care Compare group NPD
• The Josselyn Center NFP

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Grayslake, IL
  • NPI 1841078714
  NPD
• The Josselyn Center NFP

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Northbrook, IL
  • NPI 1457011934
  NPD (past)

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

{
    "created_epoch": "1351987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1351987200000",
    "number": "1871847467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 THE COURT OF HARBORSIDE",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600623228",
            "telephone_number": "847-757-5011"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 THE COURT OF HARBORSIDE",
            "city": "NORTHBROOK",
            "state": "IL",
            "postal_code": "600623228",
            "telephone_number": "847-757-5011"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLANK",
        "first_name": "SANDRA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2012-11-04",
        "last_updated": "2012-11-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149005374",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Spencer Blacketer Carlson
• Allison Jenna Blackman, PSYD
• Eve E Blackwright
• Emily Blair, MS
• Megan Blake, SLP
• Sarah Beth Blank, M.D.
• Jostein Blindheim
• Sara Blinten
• Debra M. Block, PSY.D.
• Howard Theodore Block, BSD DDS

• Clinical Social Worker in Northbrook, IL
• Providers in Northbrook, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (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.