Kertia Libretto Black, MD

Primary specialty

Physical Medicine & Rehabilitation PhysicianTaxonomy code 208100000X

License

4301061932 Issued in MI

Practice address

27725 Rainbow Cir
Lathrup Village, MI 48076-3238

Phone

(248) 910-7018

Fax

(248) 557-5409

NPI assigned

Jun 1, 2006

Last updated

Jun 22, 2020By the provider in NPPES

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

Enrolled in MI

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Interoperability endpoints

• Direct secure messaging: kblack@direct.dmc.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• University Physician Group

  dba Wayne Health

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1447299797
  Medicare reassignment
• Kertia Black MD Board Certified in Rehabilitation Medicine

  • Physical Medicine & Rehabilitation Physician
  • Lathrup Village, MI
  • NPI 1902422363
  Authorized official Same address or phone
• Rehabilitation Institute of Michigan

  • Rehabilitation Clinic/Center
  • Detroit, MI
  • NPI 1982779260
  NPD (past)

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

{
    "created_epoch": "1149120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592784000000",
    "number": "1467499954",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27725 RAINBOW CIR",
            "city": "LATHRUP VILLAGE",
            "state": "MI",
            "postal_code": "480763238",
            "telephone_number": "248-910-7018",
            "fax_number": "248-557-5409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27725 RAINBOW CIR",
            "city": "LATHRUP VILLAGE",
            "state": "MI",
            "postal_code": "480763238",
            "telephone_number": "248-910-7018",
            "fax_number": "248-557-5409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "KERTIA",
        "middle_name": "LIBRETTO",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-01",
        "last_updated": "2020-06-22",
        "certification_date": "2020-06-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208100000X",
            "taxonomy_group": "",
            "desc": "Physical Medicine & Rehabilitation",
            "state": "MI",
            "license": "4301061932",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Behavioral Care Management Group PC
• Believe in the Light Transitional Housing (Bitl Transportation)
• Monsuru Bello, RPT
• Beneficent Wellness L.L.C
• Hussein Beydoun, OWNER
• Gary P Blackburn, D.C.
• Nicola Thomas Bleggi, D.C.
• Thomas Walter Bodendorfer, PHARMD
• Jamie Lorraine Bodenhafer, L.M.S.W.
• Ronald Michael Boggs, DC

• Physical Medicine & Rehabilitation Physician in Lathrup Village, MI
• Providers in Lathrup Village, MI by specialty
• Physical Medicine & Rehabilitation Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 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.

Verify at the official NPI Registry.