Individual provider Active NPI

Gloria Gilbert Black, CRNA

  • Certified Registered Nurse Anesthetist
  • Fairfax, VA
National Provider Identifier
1003815267
Registry record updated Feb 21, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Certified Registered Nurse AnesthetistTaxonomy code 367500000X
License
0024076529 Issued in VA
Practice address
3600 Joseph Siewick Dr
Fairfax, VA 22033-1709
Phone
(703) 295-9360
Fax
(703) 295-9369
NPI assigned
Jul 19, 2005
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 21, 2019

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Anesthesiology Physician 207L00000X 0024076529 VA
Certified Registered Nurse Anesthetist 367500000X 0024076529 VA Primary

Addresses

Primary practice location

3600 Joseph Siewick Dr
Fairfax, VA 22033-1709

Mailing address

PO Box 37090
Baltimore, MD 21297-3090
Phone (703) 295-9360

Other identifiers 4

IdentifierTypeStateIssuer
1003815267MedicaidVA
296621OtherVAAMERIGROUP
K142-0002OtherVACAREFIRST
139180OtherVAANTHEM

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DC, VA, MD3 enrollments

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20050524001206 DC Practitioner - Certified Registered Nurse Anesthetist (Crna) 7416999040 Reassigns benefits to 3 organizations
I20050808001265 VA Practitioner - Certified Registered Nurse Anesthetist (Crna) 7416999040 Reassigns benefits to 2 organizations
I20140218001965 MD Practitioner - Certified Registered Nurse Anesthetist (Crna) 7416999040 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Certified Registered Nurse Anesthetist (Crna)
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Inova Cares - CommunityGroup PAC ID 9537526330, 187 clinicians

Practice addresses (Care Compare)

3600 Joseph Siewick Dr
Fairfax, VA 22033-1709
Phone (703) 391-3600

44045 Rivderside Pkwy
Leesburg, VA 20176-5101
Phone (703) 858-6000

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Certified Registered Nurse

State licenses

LicenseStateTypeSpecialty
0024076529VAMDCertified Registered Nurse Anesthetist

Practice roles

OrganizationSpecialtyStatusNew patients
Inova Cares - Community Anesthesiology CurrentSince Jun 12, 2023 Accepting new patients
American Anesthesiology of Virginia, PC Anesthesiology CurrentSince May 1, 2021 Accepting new patients
Inova Health Care Services Current Accepting new patients
American Anesthesiology of Virginia PC Anesthesiology CurrentSince May 1, 2021 Accepting new patients
Anesthesia Associates LTD. Anesthesiology Past Accepting new patients

Locations

6400 Goldsboro Rd
Ste 400
Bethesda, MD 20817
Phone (301) 263-0800

4320 Seminary Rd
Alexandria, VA 22304
Phone (703) 504-3000

2501 Parkers Ln
Alexandria, VA 22306
Phone (703) 664-7000

10730 Main St
Fairfax, VA 22030
Phone (703) 491-9500

3600 Joseph Siewick Dr
Fairfax, VA 22033
Phone (703) 391-3037

3300 Gallows Rd
Falls Church, VA 22042
Phone (703) 352-9395

6355 Walker Ln
Franconia, VA 22310
Phone (703) 664-7453

19455 Deerfield Ave
Ste 204
Leesburg, VA 20176
Phone (703) 724-9950

224B Cornwall St NW
Leesburg, VA 20176
Phone (703) 771-2894

44045 Riverside Pkwy
Leesburg, VA 20176
Phone (703) 858-6040

Organizations & group practices 6

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 1

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": "1121731200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550707200000",
    "number": "1003815267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 37090",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212973090",
            "telephone_number": "703-295-9360",
            "fax_number": "703-295-9369"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3600 JOSEPH SIEWICK DR",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220331709",
            "telephone_number": "703-295-9360",
            "fax_number": "703-295-9369"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "GLORIA",
        "middle_name": "GILBERT",
        "name_prefix": "Mrs.",
        "credential": "CRNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-07-19",
        "last_updated": "2019-02-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "VA",
            "license": "0024076529",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "VA",
            "license": "0024076529",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1003815267",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AMERIGROUP",
            "identifier": "296621",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST",
            "identifier": "K142-0002",
            "state": "VA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "139180",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Fairfax, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • 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.