Active NPI
Carla Marie Black, MD
- Child & Adolescent Psychiatry Physician
- Indianapolis, IN
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Child & Adolescent Psychiatry Physician
- License
- 01087770A
- Practice address
- 6640 Intech Blvd Ste 195
Indianapolis, IN 46278-2014 - Phone
- (317) 295-0608
- Fax
- (317) 948-0609
- NPI assigned
- May 2, 2016
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 5
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 01087770A | IN | |
| Psychiatry Physician | 2084P0800X | 310168 | LA | |
| Psychiatry Physician | 2084P0800X | 01087770A | IN | |
| Student in an Organized Health Care Education/Training Program | 390200000X | |||
| Child & Adolescent Psychiatry Physician | 2084P0804X | 01087770A | IN | Primary |
Addresses
Primary practice location
6640 Intech Blvd Ste 195
Indianapolis, IN 46278-2014
Mailing address
250 N Shadeland Ave
Indianapolis, IN 46219-4959
Other practice location 1
1430 Tulane Ave # 8055
New Orleans, LA 70112-2632
Phone (504) 988-7829
Other practice location 2
300 4th St
Bridge City, LA 70094-3320
Phone (866) 530-6111
Other practice location 3
1701 N Senate Blvd
Indianapolis, IN 46202-1239
Phone (888) 484-3258
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1102529646 | Other | IN | ANTHEM PTAN |
| 300062282 | Medicaid | IN |
Electronic endpoints 2
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | cblack@direct.iuhealth.org | Direct | |
| Direct Messaging Address | cblack@direct.iuhealth.org | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 01087770A | IN | MD | Pediatrics Physician |
| 310168 | LA | MD | Psychiatry Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Iu Health Medical Group, LLC | Current | Accepting new patients | |
| Iu Health Medical Group Riley Specialists, LLC | Pediatrics | Current | Accepting new patients |
| Indiana University Health Care Associates, Inc | Current | Accepting new patients | |
| University Medical Diagnostic Associates, Inc. | Past | Accepting new patients |
Locations
5208 Reliable Pkwy
Chicago, IL 60686
1701 N Senate Blvd
Bldg C6
Indianapolis, IN 46202
Phone (913) 962-2000
250 N Shadeland Ave
Indianapolis, IN 46219
Phone (317) 948-9174
6640 Intech Blvd
Ste 190
Indianapolis, IN 46278
Phone (317) 295-0608
705 Riley Hospital Dr
Indianapolis, IN 46202
Phone (317) 274-4779
6640 Intech Blvd
Ste 195
Indianapolis, IN 46278
Phone (317) 295-0608
1701 Senate Blvd
Indianapolis, IN 46202
Phone (317) 612-2754
Interoperability endpoints
- cblack8@direct.iuhealth.org
Organizations & group practices 4
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.
-
- General Practice Physician
- Indianapolis, IN
- NPI 1902032832
-
- Pediatrics Physician
- Indianapolis, IN
- NPI 1699561480
-
- General Practice Physician
- Indianapolis, IN
- NPI 1326893777
-
- Internal Medicine Physician
- Indianapolis, IN
- NPI 1861441537
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1462147200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1747267200000",
"number": "1124473749",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "250 N SHADELAND AVE",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462194959"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6640 INTECH BLVD STE 195",
"city": "INDIANAPOLIS",
"state": "IN",
"postal_code": "462782014",
"telephone_number": "317-295-0608",
"fax_number": "317-948-0609"
}
],
"practiceLocations": [
{
"address_1": "1430 Tulane Ave # 8055",
"address_purpose": "LOCATION",
"city": "New Orleans",
"state": "LA",
"postal_code": "701122632",
"country_code": "US",
"telephone_number": "504-988-7829",
"fax_number": "504-988-4264",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "300 4th St",
"address_purpose": "LOCATION",
"city": "Bridge City",
"state": "LA",
"postal_code": "700943320",
"country_code": "US",
"telephone_number": "866-530-6111",
"fax_number": "504-575-3691",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "1701 N Senate Blvd",
"address_purpose": "LOCATION",
"city": "Indianapolis",
"state": "IN",
"postal_code": "462021239",
"country_code": "US",
"telephone_number": "888-484-3258",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BLACK",
"first_name": "CARLA",
"middle_name": "MARIE",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-05-02",
"last_updated": "2025-05-15",
"certification_date": "2025-05-15",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "IN",
"license": "01087770A",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "LA",
"license": "310168",
"primary": false
},
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "IN",
"license": "01087770A",
"primary": false
},
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": false
},
{
"code": "2084P0804X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Child & Adolescent Psychiatry",
"state": "IN",
"license": "01087770A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM PTAN",
"identifier": "1102529646",
"state": "IN"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "300062282",
"state": "IN"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "cblack@direct.iuhealth.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "6640 Intech Blvd Ste 195",
"city": "Indianapolis",
"state": "IN",
"country_code": "US",
"postal_code": "462782014",
"country_name": "United States",
"address_type": "DOM"
},
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "cblack@direct.iuhealth.org",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"address_1": "1701 N Senate Blvd",
"city": "Indianapolis",
"state": "IN",
"country_code": "US",
"postal_code": "462021239",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}
Other providers in Indianapolis, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 15, 2025; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.