Individual provider Active NPI

Daniel M Cooley, MD

  • Anesthesiology Physician
  • Peoria, IL
National Provider Identifier
1154310100
Registry record updated Aug 3, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anesthesiology PhysicianTaxonomy code 207L00000X
License
036082211 Issued in IL
Practice address
8600 N State Route 91
Suite 250
Peoria, IL 61615-9541
Phone
(309) 692-5393
Fax
(309) 692-2538
NPI assigned
Oct 20, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 3, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 036082211 IL Primary
Pain Medicine (Anesthesiology) Physician 207LP2900X 036082211 IL
Family Medicine Physician 207Q00000X 036082211 IL

Addresses

Primary practice location

8600 N State Route 91
Suite 250
Peoria, IL 61615-9541

Mailing address

8600 N State Route 91
Suite 250
Peoria, IL 61615-9541
Phone (309) 692-5393

Other identifiers 1

IdentifierTypeStateIssuer
036082211MedicaidIL

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20101105001337 IL Practitioner - Anesthesiology 3173718913 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Anesthesiology
Education
Indiana University School of Medicine, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Associated Anesthesiologists SCGroup PAC ID 6305744129, 150 clinicians

Practice addresses (Care Compare)

530 Neglen Oak Ave
Peoria, IL 61637-0001
Phone (309) 655-2000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
036082211ILMDAnesthesiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Associated Anesthesiologists, S.C. Anesthesiology CurrentSince Jan 1, 1997 Accepting new patients

Locations

530neglen Oak Ave
Peoria, IL 61637
Phone (309) 692-5393

8600 State Route 91
Ste 250
Peoria, IL 61615
Phone (309) 692-5393

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1129766400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1280793600000",
    "number": "1154310100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8600 N STATE ROUTE 91",
            "address_2": "SUITE 250",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616159541",
            "telephone_number": "309-692-5393",
            "fax_number": "309-692-2538"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8600 N STATE ROUTE 91",
            "address_2": "SUITE 250",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616159541",
            "telephone_number": "309-692-5393",
            "fax_number": "309-692-2538"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COOLEY",
        "first_name": "DANIEL",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-10-20",
        "last_updated": "2010-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "IL",
            "license": "036082211",
            "primary": true
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "IL",
            "license": "036082211",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036082211",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036082211",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.