Molly Black

Primary specialty

Certified Registered Nurse AnesthetistTaxonomy code 367500000X

License

971137 Issued in TX

Practice address

1585 3Rd St
Fort Polk, LA 71459-5102

Phone

(210) 862-9692

NPI assigned

Nov 10, 2020

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Specialty

Certified Registered Nurse Anesthetist (Crna)

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

University Anesthesiology Associates LLCGroup PAC ID 6901702869, 239 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Ohsu Hospital and Clinics Hospital, Portland, OR, CCN 380009

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mblack197644@direct.ohsu.edu

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.

• University Anesthesiology Associates, LLC

  • Anesthesiology Physician
  • Portland, OR
  • NPI 1841217817
  Medicare reassignment Care Compare group NPD

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

• Oregon Health & Science University

  • General Acute Care Hospital
  • Portland, OR
  • NPI 1609824010
  Care Compare affiliation

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

{
    "created_epoch": "1604966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1751932800000",
    "number": "1114529674",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "43 BASSETT ST",
            "city": "FORT BRAGG",
            "state": "NC",
            "postal_code": "283072032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1585 3RD ST",
            "city": "FORT POLK",
            "state": "LA",
            "postal_code": "714595102",
            "telephone_number": "210-862-9692"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "43 Bassett St",
            "address_purpose": "LOCATION",
            "city": "Fort Bragg",
            "state": "NC",
            "postal_code": "283072032",
            "country_code": "US",
            "telephone_number": "210-862-9692",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3181 SW Sam Jackson Park Rd",
            "address_purpose": "LOCATION",
            "city": "Portland",
            "state": "OR",
            "postal_code": "972393011",
            "country_code": "US",
            "telephone_number": "503-494-7641",
            "fax_number": "503-494-4661",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "MOLLY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-10",
        "last_updated": "2025-07-08",
        "certification_date": "2025-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "OR",
            "license": "10041796",
            "primary": false
        },
        {
            "code": "367500000X",
            "taxonomy_group": "",
            "desc": "Nurse Anesthetist, Certified Registered",
            "state": "TX",
            "license": "971137",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "none",
            "affiliation": "N",
            "address_1": "43 Bassett St",
            "city": "Fort Bragg",
            "state": "NC",
            "country_code": "US",
            "postal_code": "283072032",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Tadd William Berg
• Robert Paul Bergeron, DDS
• Samson Bekele Beshia, PA-C
• Troy Louis Bidez, PA-C
• Robin Bisset, OTR/L
• Tyrette Herrington Bodine, LCSW
• Mindy Boline, RDH
• Shawn Bookwalter, PHARM D
• Antwon Boston, PHARMD
• Aprille Boudreau, PH.D.

• Certified Registered Nurse Anesthetist in Fort Polk, LA
• Providers in Fort Polk, LA by specialty
• Certified Registered Nurse Anesthetist in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2025; 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.