Dr Audrey Deanne Blacklock, MD, PHD is a medicare enrolled "Ophthalmology" physician in N Kansas City, Missouri. She went to University Of Kansas School Of Med (kc/wich/sal) and graduated in 2006 and has 18 years of diverse experience with area of expertise as Ophthalmology. She is a member of the group practice Somers Eye Center Inc and her current practice location is
2790 Clay Edwards Dr Ste 1240, N Kansas City, Missouri. You can reach out to her office (for appointments etc.) via phone at
(816) 842-2015.
Dr Audrey Deanne Blacklock is licensed to practice in Missouri (license number 2012008166) and she also participates in the medicare program. She
accepts medicare assignments (which means she accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance) and her NPI Number is 1912199159.
Physician's Profile
| Full Name | Dr Audrey Deanne Blacklock |
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| Gender | Female |
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| Speciality | Ophthalmology |
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| Experience | 18 Years |
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| Location | 2790 Clay Edwards Dr Ste 1240, N Kansas City, Missouri |
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| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
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Medical Education and Training:
- Dr Audrey Deanne Blacklock attended and graduated from University Of Kansas School Of Med (kc/wich/sal) in 2006
NPI Data:
- NPI Number: 1912199159
- Provider Enumeration Date: 08/13/2007
- Last Update Date: 10/06/2022
Medicare PECOS Information:
- PECOS PAC ID: 5395869481
- Enrollment ID: I20120607000022
Medical Identifiers
Medical identifiers for Dr Audrey Deanne Blacklock such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
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| 1912199159 | NPI | - | NPPES |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
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| 207W00000X | Ophthalmology | 04-34305 (Kansas) | Secondary |
| 207W00000X | Ophthalmology | 2012008166 (Missouri) | Primary |
Medical Facilities Affiliation
Group Practice Association
| Group Practice Name | Group PECOS PAC ID | No. of Members |
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| Somers Eye Center Inc | 9638594146 | 2 |
Medicare Reassignments
Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Dr Audrey Deanne Blacklock allows following entities to bill medicare on her behalf.
| Entity Name | Somers Eye Center Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1316045867
PECOS PAC ID: 9638594146
Enrollment ID: O20200730003505 |
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Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Audrey Deanne Blacklock is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
| Mailing Address | Practice Location Address |
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Dr Audrey Deanne Blacklock, MD, PHD
2790 Clay Edwards Dr Ste 1240,
N Kansas City, MO 64116-3253
Ph: (816) 842-2015 | Dr Audrey Deanne Blacklock, MD, PHD
2790 Clay Edwards Dr Ste 1240,
N Kansas City, MO 64116-3253
Ph: (816) 842-2015 |
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