CANDACE R BLANK (AU.D.) – Audiologist, NPI 1194056564

CANDACE R BLANK (AU.D.) is a healthcare provider. based in Maywood, Illinois. specializing in QUALIFIED AUDIOLOGIST. They hold the professional credentials AU.D.. They hold a License No. 147000175 (IL). The NPI Number for CANDACE R BLANK (AU.D.) is 1194056564

Main info

Female
Sole Proprietor
17 Years Of Experience
Accepts Medicare Assignment
Name
CANDACE R BLANK (AU.D.)
NPI
1194056564
Phone
(708) 216-3821
Address
2160 S 1ST AVE
Enumeration Date
24 January 2010
Last Update Date
1 April 2021

Doctor Profile

Medical School Name
OTHER
Secondary Phone
7087837430
Graduation Year
2009 (17 years ago)
PAC ID
1951555010
Group Practice PAC ID
6305109547
Professional Enrollment ID
I20130126000019
Address ID
IL604023472BE3231XAVEX304

Contacts

Secure Messaging
lblack98256@direct.luhs.org
Data current as of
20 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience56
Completeness85
Years active:16State licenses:1Other namesUpdated within 12 months

401 QUALIFIED AUDIOLOGIST in IL

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Provider Addresses for CANDACE R BLANK (AU.D.)

  • 2160, South 1st Avenue, Maywood, Proviso Township, Cook County, Illinois, 60153, United States

    DEPARTMENT OF AUDIOLOGY

    MAYWOOD, IL 601533328

    Phone: (708) 216-3821

    Fax: (708) 216-2137

    Mailing address matches the actual address.

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: 2013-01-26

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

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20130126000019IQualified AudiologistILTBD

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.

Verify on CMS Revalidation Lookup Tool

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.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 60153)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 6305109547View full group profile
NameSpecialtyState
Family PracticeIL
Endocrinology, Internal MedicineIL
E N D O C R I N O L O G YIL
P S Y C H I A T R YIL
Family PracticeIL
Internal MedicineIL
P S Y C H I A T R YTN
O B S T E T R I C S/ G Y N E C O L O G YIL
Internal MedicineIL
Internal MedicineIL

Reviews

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Frequently asked questions

Can I verify CANDACE R BLANK (AU.D.) with an NPI only?
You can start verification with NPI 1194056564 for CANDACE R BLANK (AU.D.), then check state licensing separately.
Is CANDACE R BLANK (AU.D.) listed as active for patients and plans?
The listing shows CANDACE R BLANK (AU.D.) as active in the NPI system.
What is CANDACE R BLANK (AU.D.)'s primary classification?
Audiologist is the headline specialty for CANDACE R BLANK (AU.D.) here. Clinical services aligned with this taxonomy classification.
Where is CANDACE R BLANK (AU.D.) based?
CANDACE R BLANK (AU.D.) is tied to Maywood, Illinois in the data we show; additional addresses may exist on the full record.
Is the information about CANDACE R BLANK (AU.D.) up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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