Individual provider Active NPI

Blake Elliot Cohen, M.D.

  • Diagnostic Radiology Physician
  • Peoria, IL
National Provider Identifier
1558650101
Registry record updated Jan 23, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
036-142632 Issued in IL
Practice address
530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone
(309) 655-2000
NPI assigned
Apr 5, 2011
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 23, 2024

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 036-142632 IL Primary
Diagnostic Radiology Physician 2085R0202X 2011018942 MO
Diagnostic Radiology Physician 2085R0202X 60184 MN

Addresses

Primary practice location

530 NE Glen Oak Ave
Peoria, IL 61637-0001

Mailing address

111 Oakwood Rd
East Peoria, IL 61611-1853
Phone (309) 740-4272

Other practice location 1

200 1st St SW
Rochester, MN 55905-0001
Phone (507) 284-2511

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
I20171116002190 IL Practitioner - Diagnostic Radiology 5395046171 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Southern Illinois University School of Medicine, 2011
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Central Illinois Radiological Associates LTDGroup PAC ID 9436061827, 205 clinicians
Cira Michigan PCGroup PAC ID 7113355264, 89 clinicians
Osf Multi-Specialty GroupGroup PAC ID 3678889789, 2,123 clinicians

Practice addresses (Care Compare)

10 Saint Clare CT
Washington, IL 61571-9239
Phone (309) 566-4062

1000 W Harlem Ave
Monmouth, IL 61462-1007
Phone (309) 734-1400

1051 W S St
Kewanee, IL 61443-8354
Phone (309) 852-7500

1100 E Norris Dr
Ottawa, IL 61350-1604
Phone (815) 433-3100

111 Spring St
Streator, IL 61364-3332
Phone (815) 673-2311

11233 N Onyx LN
Dunlap, IL 61525-9815
Phone (906) 786-5707

1400 W Park St
Urbana, IL 61801-2334
Phone (309) 740-4272

1401 E 12TH St
Mendota, IL 61342-9216
Phone (815) 539-7461

1650 Midtown Rd
Peru, IL 61354-1200
Phone (815) 538-1351

2200 E Washington St
Bloomington, IL 61701-4364
Phone (309) 662-3311

2200 Fort Jesse Rd
Suite 100
Normal, IL 61761-6286
Phone (309) 661-6280

221 NE Glen Oak Ave
Peoria, IL 61636-0001
Phone (309) 672-5522

2406 E Empire St
Bloomington, IL 61704-3630
Phone (309) 664-3161

2406 Empire St
Bloomington, IL 61704-3630
Phone (309) 740-4272

2500 W Reynolds St
Pontiac, IL 61764-9774
Phone (815) 842-2828

2800 W 95TH St
Evergreen, IL 60805-2701
Phone (309) 740-4272

3315 N Seminary St
Galesburg, IL 61401-1251
Phone (309) 344-1000

3333 N Seminary St
Galesburg, IL 61401-1251
Phone (309) 344-3161

435 Maxine Dr
Morton, IL 61550-2498
Phone (309) 263-2424

500 W Romeo B Garrett Ave
Peoria, IL 61605-2301
Phone (309) 740-4272

5114 N Glen Park Place Rd
Peoria, IL 61614-4686
Phone (309) 683-2428

5200 Reliable Pkwy
Chicago, IL 60686-0052

530 NE Glen Oak Ave
Peoria, IL 61637-0001
Phone (309) 740-4272

530 Neglen Oak Ave
Peoria, IL 61636-0001
Phone (309) 655-2000

530 Park Ave E
Perry Memorial Hosp
Princeton, IL 61356-3901
Phone (815) 875-2811

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
75 of 100Reported as group

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
036-142632ILMDDiagnostic Radiology Physician
60184MNMDDiagnostic Radiology Physician
2011018942MOMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Central PA Pharmacy LLC. Current Accepting new patients
Central Illinois Radiological Associates, LTD. Diagnostic Radiology CurrentSince Sep 25, 2017 Accepting new patients
Cira Michigan PC Diagnostic Radiology CurrentSince Jan 1, 2026 Accepting new patients
Osf Multi-Specialty Group CurrentSince Aug 20, 2025 Accepting new patients

Locations

5200 Reliable Pkwy
Chicago, IL 60686
Phone (309) 671-8748

1420 W Pioneer Pkwy
Peoria, IL 61615
Phone (309) 308-5195

111 Oakwood Rd
Peoria, IL 61611
Phone (586) 412-4144

8600 State Route 91
Ste 130
Peoria, IL 61615
Phone (309) 683-5050

530 NE Glen Oak Ave
Peoria, IL 61637
Phone (309) 655-2553

111 Spring St
Streator, IL 61364
Phone (815) 672-4587

Organizations & group practices 4

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.

Hospital & facility affiliations 4

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": "1301961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705968000000",
    "number": "1558650101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 OAKWOOD RD",
            "city": "EAST PEORIA",
            "state": "IL",
            "postal_code": "616111853",
            "telephone_number": "309-740-4272"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "530 NE GLEN OAK AVE",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616370001",
            "telephone_number": "309-655-2000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "200 1st St SW",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "MN",
            "postal_code": "559050001",
            "country_code": "US",
            "telephone_number": "507-284-2511",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "COHEN",
        "first_name": "BLAKE",
        "middle_name": "ELLIOT",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-04-05",
        "last_updated": "2024-01-23",
        "certification_date": "2024-01-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "IL",
            "license": "036-142632",
            "primary": true
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2011018942",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MN",
            "license": "60184",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Peoria, IL

Sources for this page

Verify at the official NPI Registry.