Active NPI
Angela Marie Black, PA
- Physician Assistant
- Tigard, OR
National Provider Identifier
1710063110
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA00941
- Practice address
- 11900 SW Greenburg Rd
Tigard, OR 97223-6453 - Phone
- (503) 620-5556
- Fax
- (503) 624-0118
- NPI assigned
- Oct 27, 2006
- 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 |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA00941 | OR | Primary |
Addresses
Primary practice location
11900 SW Greenburg Rd
Tigard, OR 97223-6453
Mailing address
11900 SW Greenburg Rd
Tigard, OR 97223-6453
Phone (503) 620-5556
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| PA00941 | Other | OR | STATE LICENSE |
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)
- Not enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PA00941 | OR | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| My Other Me | Past | Accepting new patients | |
| Cynthia Gulick, PC | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Family Medicine Physician
- Tigard, OR
- NPI 1467675009
-
- Gynecology Physician
- Portland, OR
- NPI 1801462080
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1710063110",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11900 SW GREENBURG RD",
"city": "TIGARD",
"state": "OR",
"postal_code": "972236453",
"telephone_number": "503-620-5556",
"fax_number": "503-624-0118"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11900 SW GREENBURG RD",
"city": "TIGARD",
"state": "OR",
"postal_code": "972236453",
"telephone_number": "503-620-5556",
"fax_number": "503-624-0118"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "ANGELA",
"middle_name": "MARIE",
"credential": "PA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-10-27",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "OR",
"license": "PA00941",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE LICENSE",
"identifier": "PA00941",
"state": "OR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tigard, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.