Samantha K Black, PA-C

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

10001929A Issued in IN

Practice address

825 Wehrle Dr
Williamsville, NY 14221

Phone

(716) 634-3243

Fax

(716) 634-6056

NPI assigned

Aug 11, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1439251200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563926400000",
    "number": "1144606351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3719 UNION RD STE 218",
            "city": "CHEEKTOWAGA",
            "state": "NY",
            "postal_code": "142254251",
            "telephone_number": "716-206-1503",
            "fax_number": "716-651-9945"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 WEHRLE DR",
            "city": "WILLIAMSVILLE",
            "state": "NY",
            "postal_code": "14221",
            "telephone_number": "716-634-3243",
            "fax_number": "716-634-6056"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4015 Gateway Blvd",
            "address_2": "Suite 2120",
            "address_purpose": "LOCATION",
            "city": "Newburgh",
            "state": "IN",
            "postal_code": "476309460",
            "country_code": "US",
            "telephone_number": "812-842-0907",
            "fax_number": "812-464-0536",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "SAMANTHA",
        "middle_name": "K",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-08-11",
        "last_updated": "2019-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "IN",
            "license": "10001929A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Andrea M Billings, MS ED CCC/SLP
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• Tina Marie Blacha, NURSE PRACTIONER
• Iva Blackburn, LPN
• Maria Blackmore
• Karen Blain, NP
• Kathleen Blaisdell, LPN
• Juan Jorge Blanco, SA-C

• Surgical Physician Assistant in Williamsville, NY
• Providers in Williamsville, NY by specialty
• Surgical Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.