Katherine M Blake, D.O.

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

036136377 Issued in IL

Practice address

131 E Park Ave Ste 103
Libertyville, IL 60048-2858

Phone

(847) 984-3290

Fax

(847) 255-2015

NPI assigned

Mar 22, 2012

Last updated

Mar 10, 2026By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 4

Addresses

Other identifiers 1

Electronic endpoints 3

Medicare fee-for-service enrollment

Enrolled in WI, IL2 enrollments

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 2

Specialty

Family Practice

Education

Lake Erie College of Osteopathic Medicine, Erie, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Lakeshore Medical Clinic LLCGroup PAC ID 7719890730, 375 clinicians

Northwestern Medical Faculty FoundationGroup PAC ID 4587576814, 4,386 clinicians

Aurora Medical Group, Inc.Group PAC ID 6709794258, 3,764 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Northwestern Memorial Hospital Hospital, Chicago, IL, CCN 140281
• Northwestern Lake Forest Hospital Hospital, Lake Forest, IL, CCN 140130

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: katherine.blake.2@3569.direct.athenahealth.com
• Direct secure messaging: kblake445043@direct.myadvocateaurora.org

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

• Northwestern Medical Faculty Foundation

  dba Northwestern Medical Group

  • Multi-Specialty Clinic/Center
  • Carol Stream, IL
  • NPI 1346235314
  Medicare reassignment Care Compare group NPD
• Aurora Medical Group, Inc.

  • Certified Registered Nurse Anesthetist
  • Milwaukee, WI
  • NPI 1427271378

  Family Medicine

  Medicare reassignment Care Compare group NPD
• Lakeshore Medical Clinic, LLC

  • Family Medicine Physician
  • St Francis, WI
  • NPI 1003861188
  Medicare reassignment Care Compare group NPD
• Ganesha Institute of Neurology and Psychiatry SC

  dba A Ray of Hope: The Great Lakes Institute of Neurology and Psychiatry

  • Neurology Physician
  • Libertyville, IL
  • NPI 1629478599
  Medicare reassignment NPD
• Ascension Medical Group-Southeast Wisconsin Inc

  dba Ascension Medical Group

  • Internal Medicine Physician
  • Glendale, WI
  • NPI 1609881077

  Family Medicine

  Medicare reassignment NPD
• Aurora Advanced Healthcare, Inc.

  • Family Medicine Physician
  • Milwaukee, WI
  • NPI 1265629133
  Medicare reassignment NPD
• Froedtert &the Medical College of Wisconsin Community Physicians, Inc.

  • Internal Medicine Physician
  • Menomonee Falls, WI
  • NPI 1568787448
  Medicare reassignment NPD
• Rosalind Franklin University Health

  • Durable Medical Equipment & Medical Supplies
  • North Chicago, IL
  • NPI 1982894911
  Medicare reassignment
• Blake Medical Care SC

  dba The Good Doc Direct Primary Care

  • Family Medicine Physician
  • Libertyville, IL
  • NPI 1013663749
  Authorized official Same address or phone
• Kim M Carnazzola MD SC

  • Family Medicine Physician
  • Libertyville, IL
  • NPI 1902104037
  NPD
• Northwestern Medical Faculty Foundation

  dba Northwestern Medical Group

  • Durable Medical Equipment & Medical Supplies
  • Chicago, IL
  • NPI 1417718479
  NPD
• Aurora Advanced Healthcare Inc

  • Durable Medical Equipment & Medical Supplies
  • Summit, WI
  • NPI 1477186633
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Northwestern Lake Forest Hospital

  dba Northwestern Medicine Lake Forest Hospital

  • General Acute Care Hospital
  • Lake Forest, IL
  • NPI 1124025176
  Care Compare affiliation
• Northwestern Memorial Hospital

  • General Acute Care Hospital
  • Chicago, IL
  • NPI 1497859649
  Care Compare affiliation

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

{
    "created_epoch": "1332374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773100800000",
    "number": "1225304322",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "131 E PARK AVE STE 103",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600482858",
            "telephone_number": "847-984-3290",
            "fax_number": "847-255-2015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 E PARK AVE STE 103",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600482858",
            "telephone_number": "847-984-3290",
            "fax_number": "847-255-2015"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "635 N Dearborn St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Chicago",
            "state": "IL",
            "postal_code": "606544618",
            "country_code": "US",
            "telephone_number": "312-694-2127",
            "fax_number": "312-694-2129",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6609 W Greenfield Ave",
            "address_purpose": "LOCATION",
            "city": "West Allis",
            "state": "WI",
            "postal_code": "532144958",
            "country_code": "US",
            "telephone_number": "414-257-8577",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "KATHERINE",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-22",
        "last_updated": "2026-03-10",
        "certification_date": "2026-03-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "125-061735",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "WI",
            "license": "64086",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IL",
            "license": "036136377",
            "primary": true
        },
        {
            "code": "207QB0002X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Obesity Medicine",
            "state": "IL",
            "license": "036136377",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100046359",
            "state": "WI"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kblake445043@direct.myadvocateaurora.org",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "6609 W Greenfield Ave",
            "city": "West Allis",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532144958",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://esmd.abilitynetwork.com:8291/Gateway/Documentsubmission/2_0/Nhinservice/XDRRequest_Service",
            "affiliation": "Y",
            "endpointDescription": "2.16.840.1.113883.3.667.2",
            "affiliationName": "Ability Network",
            "use": "OTHER",
            "useDescription": "Other",
            "useOtherDescription": "CMS esMD eMDR",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "64 S Price Rd Ste B",
            "city": "Brownsville",
            "state": "TX",
            "country_code": "US",
            "postal_code": "785212459",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://EpicFHIR.aurora.org/FHIR/MYAURORA/api/FHIR/DSTU2/",
            "affiliation": "N",
            "address_1": "6609 W Greenfield Ave",
            "city": "West Allis",
            "state": "WI",
            "country_code": "US",
            "postal_code": "532144958",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Emma Billy
• Bradley Binder
• Jonathan Birnberg, MD
• Amy L Blais, D.O.
• Blake Medical Care SC (The Good Doc Direct Primary Care)
• Crandell W Bliss, L.C.P.C.
• Jaime Block, AUD
• Lisa S Block, LCPC
• Misty Lynn Blomquist, L.AC
• Kelsey Rae George Bloom, PT, DPT

• Family Medicine Physician in Libertyville, IL
• Providers in Libertyville, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.