Audrey Deanne Blacklock, MD, PHD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

2012008166 Issued in MO

Practice address

2790 Clay Edwards Dr Ste 1240
N Kansas City, MO 64116-3253

Phone

(816) 842-2015

Fax

(816) 221-3713

NPI assigned

Aug 13, 2007

Last updated

Oct 6, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MO

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Ophthalmology

Education

University of Kansas School of Med (KC/Wich/Sal), 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Somers Eye Center IncGroup PAC ID 9638594146, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• NKC Health Hospital, North Kansas City, MO, CCN 260096

Merit-based Incentive Payment System (MIPS)

Final score

92.85 of 100Reported as group

Quality

100

Improvement activities

40

Cost

76.17

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine, Doctor of Philosophy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: ablacklock@somerseye.intellechartdirect.net

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.

• Somers Eye Center Inc

  • Ophthalmology Physician
  • North Kansas City, MO
  • NPI 1316045867
  Medicare reassignment Care Compare group NPD
• Grene Vision Group LLC

  • Ophthalmology Physician
  • Wichita, KS
  • NPI 1285627562
  NPD (past)
• Mid-America Retina Consultants PA

  • Retina Specialist (Ophthalmology) Physician
  • Overland Park, KS
  • NPI 1083794747
  NPD (past)
• Thompson Eye Clinic

  • Optometrist
  • Shawnee, KS
  • NPI 1376626317
  NPD (past)

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

• North Kansas City Hospital

  dba Skilled Nursing Unit

  • Skilled Nursing Facility
  • North Kansas City, MO
  • NPI 1437103215

  Hospital

  Care Compare affiliation
• North Kansas City Hospital

  dba NKC Health

  • General Acute Care Hospital
  • North Kansas City, MO
  • NPI 1629062799
  Care Compare affiliation

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

{
    "created_epoch": "1186963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665014400000",
    "number": "1912199159",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2790 CLAY EDWARDS DR STE 1240",
            "city": "N KANSAS CITY",
            "state": "MO",
            "postal_code": "641163253",
            "telephone_number": "816-842-2015",
            "fax_number": "816-221-3713"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2790 CLAY EDWARDS DR STE 1240",
            "city": "N KANSAS CITY",
            "state": "MO",
            "postal_code": "641163253",
            "telephone_number": "816-842-2015",
            "fax_number": "816-221-3713"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACKLOCK",
        "first_name": "AUDREY",
        "middle_name": "DEANNE",
        "name_prefix": "Dr.",
        "credential": "MD, PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-08-13",
        "last_updated": "2022-10-06",
        "certification_date": "2022-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "KS",
            "license": "04-34305",
            "primary": false
        },
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "MO",
            "license": "2012008166",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Arc Rehabilitation Services, LLC (Athletic & Rehabilitation Center)
• Charley Atkison, PA-C
• Todd J. Beardman, M.D.
• Suganthi Beeki, MD
• Larry E Benson, MD
• Colleen L Buchinger, M.D.
• Scott S Chapman, MD
• Chiropractic Kinesiology Clinic
• Concentra Health Services, Inc.
• Gregory A Cummins, DO

• Ophthalmology Physician in N Kansas City, MO
• Providers in N Kansas City, MO by specialty
• Ophthalmology Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2022; 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.