Active NPI
Khadijallah Black
- Counselor
- Cincinnati, OH
National Provider Identifier
1356063176
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counselor
- License
- C.2406122
- Practice address
- 5050 Madison Rd
Cincinnati, OH 45227-1491 - Phone
- (513) 272-2800
- NPI assigned
- Sep 19, 2022
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | C.2406122 | OH | Primary |
Addresses
Primary practice location
5050 Madison Rd
Cincinnati, OH 45227-1491
Mailing address
5124 Reading Rd Apt B
Cincinnati, OH 45237-5327
Phone (513) 562-7782
Other practice location 1
1375 Kemper Meadow Dr Ste 12
Cincinnati, OH 45240-1650
Phone (513) 294-8300
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00000 | Other | OH | LICENSURE BOARD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C.2406122 | OH | MD | Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1663545600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1722988800000",
"number": "1356063176",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5124 READING RD APT B",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452375327",
"telephone_number": "513-562-7782"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5050 MADISON RD",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452271491",
"telephone_number": "513-272-2800"
}
],
"practiceLocations": [
{
"address_1": "1375 Kemper Meadow Dr Ste 12",
"address_purpose": "LOCATION",
"city": "Cincinnati",
"state": "OH",
"postal_code": "452401650",
"country_code": "US",
"telephone_number": "513-294-8300",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "BLACK",
"first_name": "KHADIJALLAH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-09-19",
"last_updated": "2024-08-07",
"certification_date": "2024-08-07",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "OH",
"license": "C.2406122",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LICENSURE BOARD",
"identifier": "00000",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Cincinnati, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 7, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.