Marissa Black, M.D.

Primary specialty

Geriatric Medicine (Internal Medicine) PhysicianTaxonomy code 207RG0300X

License

MD60571983 Issued in WA

Practice address

11521 NE 128TH St Ste 100
Kirkland, WA 98034

Phone

(425) 899-6800

Fax

(425) 899-6818

NPI assigned

Mar 21, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

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

Specialty

Geriatric MedicineAlso: Internal Medicine

Education

Tulane University School of Medicine, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Select Outpatient Services IncGroup PAC ID 4082868815, 750 clinicians

Select Rehabilitation, LLCGroup PAC ID 9032020490, 1,935 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Evergreenhealth Home Care Services Home health agency, Kirkland, WA, CCN 507079

Merit-based Incentive Payment System (MIPS)

Final score

86.73 of 100Reported as apm

Quality

73.46

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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.

• King County Public Hospital District No 2

  • Neuromusculoskeletal Medicine & OMM Physician
  • Kirkland, WA
  • NPI 1801986070
  Medicare reassignment NPD
• Select Rehabilitation, LLC

  • Rehabilitation Clinic/Center
  • Glenview, IL
  • NPI 1346368248
  Care Compare group
• King County Public Hospital District No 2

  • Internal Medicine Physician
  • Kirkland, WA
  • NPI 1467542639
  NPD
• King County Public Hospital District No. 2

  • Physical Therapist
  • Kirkland, WA
  • NPI 1356920946
  NPD
• King County Public Hospital District No 2

  • Obstetrics Physician
  • Kirkland, WA
  • NPI 1891883435
  NPD (past)
• King County Public Hospital District No 2

  • Family Medicine Physician
  • Bothell, WA
  • NPI 1902907165
  NPD (past)

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

• King County Public Hospital District No. 2

  • Home Health Agency
  • Kirkland, WA
  • NPI 1588662761
  Care Compare affiliation

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

{
    "created_epoch": "1363824000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563321600000",
    "number": "1114269735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11521 NE 128TH ST STE 100",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "980344317",
            "telephone_number": "425-899-6800",
            "fax_number": "425-899-6818"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11521 NE 128TH ST STE 100",
            "city": "KIRKLAND",
            "state": "WA",
            "postal_code": "98034",
            "telephone_number": "425-899-6800",
            "fax_number": "425-899-6818"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "325 9th Ave",
            "address_2": "Box 359755, Rm. 5048 PSB",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981042420",
            "country_code": "US",
            "telephone_number": "206-744-9102",
            "fax_number": "206-744-9976",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1660 S Columbian Way",
            "address_purpose": "LOCATION",
            "city": "Seattle",
            "state": "WA",
            "postal_code": "981081532",
            "country_code": "US",
            "telephone_number": "206-762-1010",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11521 NE 128th St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Kirkland",
            "state": "WA",
            "postal_code": "98034",
            "country_code": "US",
            "telephone_number": "425-899-6800",
            "fax_number": "425-899-6818",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "MARISSA",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-03-21",
        "last_updated": "2019-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "WA",
            "license": "MD60371542",
            "primary": false
        },
        {
            "code": "207RG0300X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Geriatric Medicine",
            "state": "WA",
            "license": "MD60571983",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kory Bizal
• Jacob Bjork
• Victoria Black Horse, M.D.
• Cody Alan Black
• Jaishaun Black
• Olivia Christine Blackshie
• Tennille Kelsey Blair, N.D.
• Blake Davis PLLC
• Jennifer Blanchard
• Jillian Mackenzie Blanco, DNP, FNP-C

• Geriatric Medicine (Internal Medicine) Physician in Kirkland, WA
• Providers in Kirkland, WA by specialty
• Geriatric Medicine (Internal Medicine) Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 17, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.