NPIMap

Individual provider Active NPI

Nicholas Dean Black, MD

  • Emergency Medicine Physician
  • Fresno, CA
National Provider Identifier
1154852689
Registry record updated Aug 2, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
A157708 Issued in CA
Practice address
2823 Fresno St
Fresno, CA 93721-1324
Phone
(559) 443-2682
Fax
(559) 443-2681
NPI assigned
Mar 26, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 2, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X A157708 CA Primary

Addresses

Primary practice location

2823 Fresno St
Fresno, CA 93721-1324

Mailing address

2625 E Divisadero St
Fresno, CA 93721-1431
Phone (559) 443-2682

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20210621002079 CA Practitioner - Emergency Medicine 2062812514 Reassigns benefits to 6 organizations

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Raleigh Emergency Medicine Associates IncGroup PAC ID 9537067343, 26 clinicians

Practice addresses (Care Compare)

4420 Lake Boone TRL
Raleigh, NC 27607-7505
Phone (919) 784-3100

Hospital & facility affiliations

  • Community Regional Medical Center Hospital, Fresno, CA, CCN 050060
  • Rex Hospital Hospital, Raleigh, NC, CCN 340114

Merit-based Incentive Payment System (MIPS)

Final score
93.01 of 100Reported as group
Quality
76.71
Promoting interoperability
100
Improvement activities
40
Cost
74

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
A157708CAMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
University Faculty Associates, Inc. Emergency Medicine CurrentSince Sep 1, 2022 Accepting new patients
Central California Faculty Medical Group, Inc. Emergency Medicine CurrentSince Dec 1, 2024 Accepting new patients
Regents of the University of California CurrentSince May 20, 2021 Accepting new patients
Regents of the University of California Emergency Medicine CurrentSince Jul 1, 2021 Accepting new patients
UC San Diego Health Community Group CurrentSince Jul 18, 2021 Accepting new patients
University Faculty Associates, Inc. CurrentSince Sep 1, 2022 Accepting new patients
Regents of the University of California Emergency Medicine CurrentSince May 20, 2021 Accepting new patients
Central California Faculty Medical Group, Inc. CurrentSince Dec 1, 2024 Accepting new patients
United Health Centers of the San Joaquin Valley Past Accepting new patients

Locations

155 N Fresno St
Fresno, CA 93701
Phone (559) 499-6440

2823 Fresno St
Fresno, CA 93721
Phone (559) 459-3965

2625 E Divisadero St
Fresno, CA 93721
Phone (559) 453-5200

2335 E Kashian Ln
Ste 240
Fresno, CA 93701
Phone (559) 320-0545

290 N Wayte Ln
Ste 1800
Fresno, CA 93701

9300 Campus Point Dr
La Jolla, CA 92037
Phone (619) 957-7000

2400 E 4th St
National City, CA 91950
Phone (619) 470-4141

16950 Via Tazon
San Diego, CA 92127
Phone (858) 521-2265

200 W Arbor Dr
#8676
San Diego, CA 92103
Phone (619) 543-6213

200 W Arbor Dr
San Diego, CA 92103
Phone (619) 543-5754

Organizations & group practices 11

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.

Hospital & facility affiliations 2

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

NPI Registry JSON

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

{
    "created_epoch": "1490486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1659398400000",
    "number": "1154852689",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 E DIVISADERO ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937211431",
            "telephone_number": "559-443-2682",
            "fax_number": "559-443-2681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2823 FRESNO ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937211324",
            "telephone_number": "559-443-2682",
            "fax_number": "559-443-2681"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "NICHOLAS",
        "middle_name": "DEAN",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-03-26",
        "last_updated": "2022-08-02",
        "certification_date": "2022-08-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "CA",
            "license": "A157708",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fresno, CA

Sources for this page

Verify at the official NPI Registry.