BLAKE KATHLEEN GOMEZ (CPNP-AC) – Pediatric Nurse Practitioner, NPI 1447723796
Pediatric Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
11,637 NURSE PRACTITIONER in IL
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Provider Addresses for BLAKE KATHLEEN GOMEZ (CPNP-AC)
Dempster Street, Buffalo, Erie County, New York, 14206, United States
PARK RIDGE, IL 600681110
Phone: (855) 312-5437
Type: Location
4400 W 95th St
Oak Lawn, IL 604532654
Phone: (708) 684-8000
Type: Location
1675 Dempster St
Park Ridge, IL 600681110
Phone: (855) 312-5437
Type: Location
345 Smith Ave N
Saint Paul, MN 551022346
Phone: (612) 813-7888
Fax: (612) 813-6361
Type: Location
2525 CHICAGO AVE
MINNEAPOLIS, MN 554044518
Phone: (612) 813-7888
Fax: (612) 813-6361
Type: Location
10860, Kingsborough Trail, Cottage Grove, Washington County, Minnesota, 55016, United States
COTTAGE GROVE, MN 550164660
Phone: (651) 769-5002
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: 2021-07-12
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 |
|---|---|---|---|---|
| I20210712001258 | I | Nurse Practitioner | MN | 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.
No Medicare fee-for-service utilization data available for this provider in our database.
Insurance plans in this area (ZIP 60068)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| - | MN | |
| Pediatric Medicine | MN | |
| Diagnostic Radiology | MN | |
| Nurse Practitioner | MN | |
| H E M A T O L O G Y/ O N C O L O G Y | MN | |
| Nuclear Medicine, Pediatric Medicine, Diagnostic Radiology | KY | |
| - | MN | |
| - | MN | |
| Nurse Practitioner | MN | |
| H E M A T O L O G Y/ O N C O L O G Y | MN |
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