Katelyn Black
Individual provider Active NPI Physician Assistant · Everett, PA
NPI 1104298306 · NPPES record last updated Mar 25, 2021
Key facts
- NPI
- 1104298306
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- MA057785 (PA)
- Practice address
- 10455 Lincoln Hwy
Everett, PA 15537-7046 - Phone
- (814) 623-6161
- NPI assigned
- Oct 27, 2015
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 5
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in PA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160912002098 | PA | Practitioner - Physician Assistant | 9537455852 | Reassigns benefits to 3 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Upmc Altoona Regional Health Services, Inc | Current | Accepting new patients | |
| Upmc Bedford Memorial | Current |
Accepting new patients | |
| Upmc Bedford Memorial | Current |
Accepting new patients | |
| Upmc Altoona | Current |
Accepting new patients | |
| Upmc Altoona | Current |
Accepting new patients |
Locations
620 Howard Ave
Altoona, PA 16601
Phone (814) 889-2011
501 Howard Ave
Ste F2
Altoona, PA 16601
Phone (814) 889-2020
1414 9th Ave
Altoona, PA 16602
Phone (814) 949-7621
10455 Lincoln Hwy
Everett, PA 15537
Phone (814) 623-3550
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | MA057785 | PA | Yes |
Addresses
Primary practice location
10455 Lincoln Hwy
Everett, PA 15537-7046
Mailing address
101 Carson Heights Dr
Duncansville, PA 16635-6547
Electronic endpoints
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | katelyn.m.black@upmcdirect.com | UPMC |
Other providers in Everett, PA
- Bedford Regional Urology
- Bedford Regional Urology, P.C.
- Bedford Surgical Associates, Inc.
- Nicole Dawn Beegle
- Elliott Jody Bilofsky
- Susan Black
- Timothy A Black
- Blair Regenerative Medicine LLC
- Dawn M Bowman
- Brande Saad Group-Bedford
All providers in Everett, PA · Physician Assistant in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 25, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.