NPIMap

Individual provider Active NPI

Lily Ann Black, MD

  • Family Medicine Physician
  • Roslindale, MA
National Provider Identifier
1609495514
Registry record updated Apr 2, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
1016219 Issued in MA
Practice address
4199 Washington St
Roslindale, MA 02131-1733
Phone
(405) 821-1155
NPI assigned
Apr 10, 2020
Last updated
Apr 2, 2024By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 1016219 MA Primary

Addresses

Primary practice location

4199 Washington St
Roslindale, MA 02131-1733

Mailing address

4199 Washington St
Roslindale, MA 02131-1733
Phone (405) 821-1155

Other practice location 1

1 Boston Medical Center Place
Dowling 5th FL
Boston, MA 02118
Phone (617) 414-4465

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20231020001509 MA Practitioner - Family Practice 7810319621 Reassigns benefits to 4 organizations

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Other, 2020
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

4199 Washington St
Roslindale, MA 02131-1733
Phone (617) 323-4440

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Boston University Obstetrics and Gynecology Foundation, Inc. CurrentSince Nov 1, 2023 Accepting new patients
Boston University Family Medicine, Inc. Family Medicine CurrentSince Nov 1, 2023 Accepting new patients
Child Health Foundation of Boston, Inc. CurrentSince Mar 1, 2024 Accepting new patients
Boston Medical Center Corporation CurrentSince Nov 1, 2023 Accepting new patients
Boston Medical Center Corporation Past Accepting new patients

Locations

1 Boston Medical Ctr Pl
#5
Boston, MA 02118
Phone (617) 414-4050

1 Boston Medical Ctr Pl
Fl 5
Boston, MA 02118
Phone (617) 414-3345

720 Harrison Ave
Ste 1105
Boston, MA 02118
Phone (617) 414-2000

850 Harrison Ave
#4
Boston, MA 02118
Phone (617) 414-2000

960 Massachusetts Ave
Ste 2
Boston, MA 02118
Phone (617) 414-7399

4199 Washington St
Roslindale, MA 02131
Phone (617) 323-4440

1 Boston Medical Ctr Pl
Roxbury, MA 02118
Phone (617) 414-5245

Interoperability endpoints

  • Direct secure messaging: lblack668731@direct.ochin.org

Organizations & group practices 6

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.

Hospital & facility affiliations 8

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": "1586476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712016000000",
    "number": "1609495514",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4199 WASHINGTON ST",
            "city": "ROSLINDALE",
            "state": "MA",
            "postal_code": "021311733",
            "telephone_number": "405-821-1155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4199 WASHINGTON ST",
            "city": "ROSLINDALE",
            "state": "MA",
            "postal_code": "021311733",
            "telephone_number": "405-821-1155"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1 Boston Medical Center Place",
            "address_2": "Dowling 5th FL",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "02118",
            "country_code": "US",
            "telephone_number": "617-414-4465",
            "fax_number": "617-414-3345",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "LILY",
        "middle_name": "ANN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-10",
        "last_updated": "2024-04-02",
        "certification_date": "2024-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MA",
            "license": "1016219",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roslindale, MA

Sources for this page

Verify at the official NPI Registry.