Active NPI
Mikal Ashley Hicks-Black, D.O.
- Psychiatry Physician
- Philadelphia, PA
National Provider Identifier
1427472299
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- OT015506
- Practice address
- 4200 Monument Rd
Philadelphia, PA 19131-1625 - Phone
- (215) 581-3701
- Fax
- (215) 581-3993
- NPI assigned
- Feb 13, 2014
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | OT015506 | PA | Primary |
Addresses
Primary practice location
4200 Monument Rd
Philadelphia, PA 19131-1625
Mailing address
4200 Monument Rd
Philadelphia, PA 19131-1625
Phone (215) 977-2000
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OT015506 | PA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1392249600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1581379200000",
"number": "1427472299",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4200 MONUMENT RD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191311625",
"telephone_number": "215-977-2000",
"fax_number": "215-581-3993"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4200 MONUMENT RD",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191311625",
"telephone_number": "215-581-3701",
"fax_number": "215-581-3993"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HICKS-BLACK",
"first_name": "MIKAL",
"middle_name": "ASHLEY",
"credential": "D.O.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-02-13",
"last_updated": "2020-02-11",
"certification_date": "2020-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "PA",
"license": "OT015506",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2020; 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.