KATHLEEN STACIE THEILACKER (AUD) – Audiologist, NPI 1205348166
Audiologist
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
600 QUALIFIED AUDIOLOGIST in CA
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Provider Addresses for KATHLEEN STACIE THEILACKER (AUD)
Ridge Line Drive, Chino Hills, San Bernardino County, California, 91709, United States
SAN BERNARDINO, CA 924074172
Phone:
Type: Mailing
9280 SE SUNNYBROOK BLVD STE 300
CLACKAMAS, OR 970159353
Phone: (503) 233-5548
Fax: (503) 230-1009
Type: Mailing
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2022-10-03
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20221003002999 | I | Qualified Audiologist | OR | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 92557 | Comprehensive hearing and speech recognition test | 129 | 113 | $0 |
| 92567 | Test to assess middle ear function | 129 | 110 | $0 |
Insurance plans in this area (ZIP 92407)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| O T O L A R Y N G O L O G Y | OR | |
| Qualified Audiologist | OR | |
| O T O L A R Y N G O L O G Y | CA | |
| - | OR | |
| - | OR | |
| - | OR | |
| Qualified Audiologist | OR | |
| Physician Assistant | OR | |
| O T O L A R Y N G O L O G Y | OR | |
| Otolaryngology, Maxillofacial Surgery, Plastic And Reconstructive Surgery | OR |
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