TRACI LEIGH BLAKE (DNP,ACNPC-AG, CRNFA) – Acute Care Nurse Practitioner, NPI 1649543042
Acute Care Nurse Practitioner
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
11,632 NURSE PRACTITIONER in IL
Provider Addresses for TRACI LEIGH BLAKE (DNP,ACNPC-AG, CRNFA)
PO BOX 1567
ROCKFORD, IL 611100067
Phone: (779) 696-7285
Type: Mailing
1401 E STATE ST
ROCKFORD, IL 611042315
Phone: (779) 696-7150
Type: Location
8201 E RIVERSIDE BLVD
ROCKFORD, IL 611142300
Phone: (815) 971-7000
Type: Location
1401 E State St
Rockford, IL 611042315
Phone: (779) 696-7150
Type: Location
1000 Mineral Point Ave
Janesville, WI 535482982
Phone: (608) 756-6868
Fax: (608) 756-6289
Type: Location
PO BOX 78866
MILWAUKEE, WI 532788866
Phone: (779) 696-4400
Type: Mailing
2563 W CREEDY RD # 1
BELOIT, WI 535118707
Phone:
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: 2025-05-19
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking 2 Medicare enrollment records; no due dates published yet.
Enrollment records
2
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 |
|---|---|---|---|---|
| I20250513002155 | I | Nurse Practitioner | IL | TBD |
| I20250519002686 | I | Nurse Practitioner | WI | 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 61110)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Radiation Oncology | WI | |
| - | IL | |
| - | IL | |
| Nurse Practitioner | IL | |
| Family Practice | IL | |
| - | IL | |
| Emergency Medicine | IL | |
| Hematology/Oncology, Internal Medicine | IL | |
| - | IL | |
| - | IL |
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