Individual provider Active NPI

Carla Marie Black, MD

  • Child & Adolescent Psychiatry Physician
  • Indianapolis, IN
National Provider Identifier
1124473749
Registry record updated May 15, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Child & Adolescent Psychiatry PhysicianTaxonomy code 2084P0804X
License
01087770A Issued in IN
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

Updated by the provider on May 15, 2025

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

Specialties & licenses 5

Specialty (taxonomy)CodeLicenseStatePrimary
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

IdentifierTypeStateIssuer
1102529646OtherINANTHEM PTAN
300062282MedicaidIN

Electronic endpoints 2

TypeEndpointUseAffiliation
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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20220609000353 IN Practitioner - PsychiatryPractitioner - Pediatric Medicine 0941595136 Reassigns benefits to 3 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
01087770AINMDPediatrics Physician
310168LAMDPsychiatry Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Iu Health Medical Group, LLC CurrentSince Jul 1, 2025 Accepting new patients
Iu Health Medical Group Riley Specialists, LLC Pediatrics CurrentSince Jan 1, 2026 Accepting new patients
Indiana University Health Care Associates, Inc CurrentSince Aug 1, 2022 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

  • Direct secure messaging: 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.

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

Verify at the official NPI Registry.