Active NPI
Randall Carl Black, LCSW
- Clinical Social Worker
- Pearland, TX
National Provider Identifier
1043322068
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- S23276
- Practice address
- 1610 Calico Canyon LN
Pearland, TX 77581-5574 - Phone
- (281) 450-7724
- Fax
- (866) 642-6202
- NPI assigned
- Aug 31, 2006
- Last updated
- Mar 7, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | S23276 | TX | |
| Clinical Social Worker | 1041C0700X | S23276 | TX | Primary |
| Case Manager/Care Coordinator | 171M00000X | 23276 | TX |
Addresses
Primary practice location
1610 Calico Canyon LN
Pearland, TX 77581-5574
Mailing address
1610 Calico Canyon LN
Pearland, TX 77581-5574
Phone (281) 450-7724
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| S23276 | TX | MD | Social Worker |
| 23276 | TX | MD | Oral and Maxillofacial Surgery (Dentist) |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Mys Counseling & Assessment PLLC | Past | Accepting new patients | |
| E R American Healthcare Services | Past | Accepting new patients | |
| Red Healthcare LLC | Past | Accepting new patients |
Organizations & group practices 3
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.
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NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1156982400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1646611200000",
"number": "1043322068",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1610 CALICO CANYON LN",
"city": "PEARLAND",
"state": "TX",
"postal_code": "775815574",
"telephone_number": "281-450-7724",
"fax_number": "866-642-6202"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1610 CALICO CANYON LN",
"city": "PEARLAND",
"state": "TX",
"postal_code": "775815574",
"telephone_number": "281-450-7724",
"fax_number": "866-642-6202"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "RANDALL",
"middle_name": "CARL",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-31",
"last_updated": "2022-03-07",
"certification_date": "2022-02-28",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "TX",
"license": "S23276",
"primary": false
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "TX",
"license": "S23276",
"primary": true
},
{
"code": "171M00000X",
"taxonomy_group": "",
"desc": "Case Manager/Care Coordinator",
"state": "TX",
"license": "23276",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pearland, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.