NPIMap

Individual provider Active NPI

Judi Ellen Blake, PA-C

  • Surgical Physician Assistant
  • Glenview, IL
National Provider Identifier
1548916786
Registry record updated Aug 5, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgical Physician AssistantTaxonomy code 363AS0400X
License
085009438 Issued in IL
Practice address
2100 Pfingsten Rd Ste 3001
Glenview, IL 60026-1301
Phone
(847) 657-5815
Fax
(847) 657-3724
NPI assigned
Feb 25, 2022
Last updated
Aug 5, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 5, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 085009438 IL
Surgical Physician Assistant 363AS0400X 085009438 IL Primary

Addresses

Primary practice location

2100 Pfingsten Rd Ste 3001
Glenview, IL 60026-1301

Mailing address

2100 Pfingsten Rd Ste 3001
Glenview, IL 60026-1301
Phone (847) 657-5815

Other practice location 1

1300 E Central Rd
Arlington Heights, IL 60005-2857
Phone (847) 870-6100

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230123002203 IL Practitioner - Physician Assistant 0345611752 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2022
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1300 E Central Rd
Arlington Heights, IL 60005-2857
Phone (847) 870-6100

2101 Waukegan Rd
Bannockburn, IL 60015-1836

800 W Central Rd
Arlington Heights, IL 60005-2349
Phone (847) 618-1000

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
84.9 of 100Reported as group
Quality
75.91
Promoting interoperability
99
Improvement activities
40
Cost
74.6

Merit-based Incentive Payment System (MIPS)

Final score
93.41 of 100Reported as group
Quality
86.81
Improvement activities
40
Cost
77.34

Merit-based Incentive Payment System (MIPS)

Final score
81.07 of 100Reported as group
Quality
76.54
Promoting interoperability
83
Improvement activities
40
Cost
74.52

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Practice roles

OrganizationSpecialtyStatusNew patients
Illinois Bone and Joint Institute LLC CurrentSince Apr 25, 2024 Accepting new patients
Endeavor Health Medical Group CurrentSince Aug 1, 2024 Accepting new patients
Cepamerica Illinois LLP CurrentSince Jan 9, 2023 Accepting new patients
Illinois Bone and Joint Institute, LLC CurrentSince Apr 25, 2024 Accepting new patients
Cepamerica Illinois LLP CurrentSince Jan 9, 2023 Accepting new patients

Locations

1601 Cummins Dr
Ste D
Modesto, CA 95358
Phone (510) 851-7423

1300 E Central Rd
Arlington Hts, IL 60005
Phone (847) 255-5036

2101 Waukegan Rd
Ste 110
Bannockburn, IL 60015
Phone (847) 914-9096

5057 Paysphere Cir
Chicago, IL 60674

9532 Eagle Way
Chicago, IL 60678

900 Rand Rd
Ste 300
Des Plaines, IL 60016
Phone (847) 324-3090

1425 N Randall Rd
Elgin, IL 60123
Phone (224) 783-5437

2650 Ridge Ave
Ste 1223
Evanston, IL 60201
Phone (847) 982-3175

2650 Ridge Ave
Ste 2218A
Evanston, IL 60201
Phone (847) 503-4222

2100 Pfingsten Rd
Ste 3001
Glenview, IL 60026
Phone (847) 657-5815

21481 N Rand Rd
Fl 2
Kildeer, IL 60047
Phone (847) 221-4900

Organizations & group practices 8

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.

Hospital & facility affiliations 8

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

NPI Registry JSON

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

{
    "created_epoch": "1645747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722816000000",
    "number": "1548916786",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2100 PFINGSTEN RD STE 3001",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600261301",
            "telephone_number": "847-657-5815",
            "fax_number": "847-657-3724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2100 PFINGSTEN RD STE 3001",
            "city": "GLENVIEW",
            "state": "IL",
            "postal_code": "600261301",
            "telephone_number": "847-657-5815",
            "fax_number": "847-657-3724"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1300 E Central Rd",
            "address_purpose": "LOCATION",
            "city": "Arlington Heights",
            "state": "IL",
            "postal_code": "600052857",
            "country_code": "US",
            "telephone_number": "847-870-6100",
            "fax_number": "847-870-8159",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLAKE",
        "first_name": "JUDI",
        "middle_name": "ELLEN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-25",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "IL",
            "license": "085009438",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IL",
            "license": "085009438",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Glenview, IL

Sources for this page

Verify at the official NPI Registry.