Laurie Jo Black, RN CNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

R217274-5 Issued in MN

Practice address

1200 6TH Ave N
Centra Care Clinic
Saint Cloud, MN 56303-2735

Phone

(320) 251-2700

Fax

(727) 587-7739

NPI assigned

Jan 4, 2006

Last updated

Nov 20, 2014By 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 2

Addresses

Other identifiers 1

Other names 1

• Laurie Jo Pereira Other name

Medicare fee-for-service enrollment

Enrolled in MN

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: lblack216653@direct.centracare.com

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.

• Centracare Clinic

  dba CentraCare - River Campus Clinic

  • Multi-Specialty Clinic/Center
  • Saint Cloud, MN
  • NPI 1043212665
  Medicare reassignment NPD
• Gillette Children's Specialty Healthcare

  dba Gillette Children's Professional Services

  • Multi-Specialty Clinic/Center
  • Saint Paul, MN
  • NPI 1225119175
  Medicare reassignment NPD
• Centracare Clinic

  dba CentraCare Sleep Center

  • Sleep Disorder Diagnostic Clinic/Center
  • Saint Cloud, MN
  • NPI 1295910727
  NPD
• Centracare Clinic

  dba CentraCare Occupations Health

  • Occupational Medicine Clinic/Center
  • Saint Cloud, MN
  • NPI 1366192759
  NPD
• Gillette Children's Specialty Healthcare

  • Multi-Specialty Clinic/Center
  • Saint Cloud, MN
  • NPI 1982090528
  NPD

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

{
    "created_epoch": "1136332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1416441600000",
    "number": "1679551329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 6TH AVE N",
            "address_2": "CENTRA CARE CLINIC",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032735",
            "telephone_number": "320-251-2700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 6TH AVE N",
            "address_2": "CENTRA CARE CLINIC",
            "city": "SAINT CLOUD",
            "state": "MN",
            "postal_code": "563032735",
            "telephone_number": "320-251-2700",
            "fax_number": "727-587-7739"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "LAURIE",
        "middle_name": "JO",
        "credential": "RN CNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-04",
        "last_updated": "2014-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "MN",
            "license": "R217274-5",
            "primary": true
        },
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "FL",
            "license": "ARNP2638602",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0307418800",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAURIE",
            "last_name": "PEREIRA",
            "middle_name": "JO",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kalie Bisel, CRNA
• Sushrit Bisht
• Laurie Jeanne Bisila, RN
• Taylor Paige Biskey
• Eric Anthony Black
• Tanya J Black, APRN, BC
• Michael Blackburn, AU.D.
• Laisha Blair
• Jill Blanchard, OTR/L
• Daniel Blatt

• Pediatric Nurse Practitioner in Saint Cloud, MN
• Providers in Saint Cloud, MN by specialty
• Pediatric Nurse Practitioner in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2014; 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.