Derek John Black

Primary specialty

Case Manager/Care CoordinatorTaxonomy code 171M00000X

Practice address

475 W 1465 N Apt 103
Logan, UT 84341-6619

Phone

(435) 851-3813

NPI assigned

Dec 1, 2021

Sex

Male

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1638316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1638316800000",
    "number": "1679231237",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "475 W 1465 N APT 103",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843416619",
            "telephone_number": "435-851-3873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "475 W 1465 N APT 103",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "843416619",
            "telephone_number": "435-851-3813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "DEREK",
        "middle_name": "JOHN",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-12-01",
        "last_updated": "2021-12-01",
        "certification_date": "2021-12-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Denny K Bird
• Erica Dawn Bishop
• James William Bishop, D.O.
• Theral Michael Bishop, MD
• Danielle Lee Bivin
• Lyle H Black, MPT
• Anne Sadler Blackett, DO
• Jessica Rene Blair
• Rebecca Kate Blais, PHD
• Mikaela Blake, RDN

• Case Manager/Care Coordinator in Logan, UT
• Providers in Logan, UT by specialty
• Case Manager/Care Coordinator in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.