DR. AUDREY DEANNE BLACKLOCK (MD, PHD) – Ophthalmology Physician, NPI 1912199159
Ophthalmology Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
444 OPHTHALMOLOGY in MO
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Provider Addresses for DR. AUDREY DEANNE BLACKLOCK (MD, PHD)
2790 CLAY EDWARDS DR STE 1240
N KANSAS CITY, MO 641163253
Phone: (816) 842-2015
Fax: (816) 221-3713
Type: Mailing
4231, Northwest 76th Terrace, Kansas City, Platte County, Missouri, 64151, United States
KANSAS CITY, MO 641517825
Phone: (316) 712-2922
Type: Mailing
1200, Landmark Avenue, Liberty, Clay County, Missouri, 64068, United States
LIBERTY, MO 640681051
Phone: (816) 792-1900
Fax: (816) 792-3548
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
CMS reports 7 Open Payments records for all available years, with a total value of $126.
Total Amount is formed as General ($126) + Research ($0) + Ownership ($0) = $126.
Last reported payment date: 2024-11-12 • Largest payer in this snapshot: Sun Pharmaceutical Industries Inc. ($40).
Total Amount
$126
General + Research + Ownership
Payments
7
Total payment records
General Amount
$126
General payments
Research Amount
$0
Research funding
Ownership Amount
$0
Ownership interests
Ownership Count
0
Ownership records
Last Payment Date
2024-11-12
Latest reported date
Top Companies
Largest payers in this snapshot
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: 2012-06-07
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 |
|---|---|---|---|---|
| I20120607000022 | I | Ophthalmology | MO | 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 |
|---|---|---|---|---|
| 92014 | Established patient complete exam of visual system | 567 | 522 | $0 |
| 92012 | Established patient problem focused exam of visual system | 228 | 175 | $0 |
| 92250 | Photography of the retina | 159 | 151 | $0 |
| 92134 | Imaging of retina | 134 | 121 | $0 |
| 92133 | Imaging of optic nerve | 108 | 99 | $0 |
Insurance plans in this area (ZIP 64116)
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Provider's Procedures
Group practice members
| Name | Specialty | State |
|---|---|---|
| O P T O M E T R Y | KS |
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