Active NPI
Vicki L Black, M.D.
- Family Medicine Physician
- Yakima, WA
National Provider Identifier
1609875038
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- MD00015749
- Practice address
- 1806 W Lincoln Ave
Yakima, WA 98902-2473 - Phone
- (509) 452-4520
- Fax
- (509) 452-5224
- NPI assigned
- Jul 18, 2005
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | MD00015749 | WA | Primary |
Addresses
Primary practice location
1806 W Lincoln Ave
Yakima, WA 98902-2473
Mailing address
1806 W Lincoln Ave
Yakima, WA 98902-2473
Phone (509) 452-4520
Other identifiers 4
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0039695 | Other | WA | LABOR & INDUSTRIES |
| 1034487 | Medicaid | WA | |
| P000050810 | Other | WA | RAILROAD MEDICARE |
| 8931362 | Other | WA | CRIME VICTIMS |
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)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD00015749 | WA | MD | Family Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1121644800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1368662400000",
"number": "1609875038",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1806 W LINCOLN AVE",
"city": "YAKIMA",
"state": "WA",
"postal_code": "989022473",
"telephone_number": "509-452-4520",
"fax_number": "509-452-5224"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1806 W LINCOLN AVE",
"city": "YAKIMA",
"state": "WA",
"postal_code": "989022473",
"telephone_number": "509-452-4520",
"fax_number": "509-452-5224"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "VICKI",
"middle_name": "L",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2005-07-18",
"last_updated": "2013-05-16",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "WA",
"license": "MD00015749",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "LABOR & INDUSTRIES",
"identifier": "0039695",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1034487",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P000050810",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CRIME VICTIMS",
"identifier": "8931362",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Yakima, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.