Individual provider Active NPI

Audrey Marie Black

  • Occupational Therapist
  • Indianapolis, IN
National Provider Identifier
1740671999
Registry record updated Apr 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Occupational TherapistTaxonomy code 225X00000X
License
31005824A Issued in IN
Practice address
8501 Harcourt Rd
Indianapolis, IN 46260-2046
Phone
(317) 875-9105
Fax
(317) 808-8802
NPI assigned
Feb 10, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Occupational Therapist 225X00000X 31005824A IN Primary

Addresses

Primary practice location

8501 Harcourt Rd
Indianapolis, IN 46260-2046

Mailing address

5765 Oriole CT
Cincinnati, OH 45227-3536
Phone (513) 240-1483

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20201201001140 IN Practitioner - Occupational Therapist in Private Practice 1254742984 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
31005824AINMDOccupational Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Orthopaedics-Indianapolis, Inc Occupational Therapist Current Accepting new patients
Hand Surgery Associates of Indiana Inc CurrentSince Dec 9, 2020 Accepting new patients
Hand Surgery Associates of Indiana, Inc. Occupational Therapist CurrentSince Dec 9, 2020 Accepting new patients

Locations

1115 Ronald Reagan Pkwy
Ste 224
Avon, IN 46123
Phone (317) 272-1155

13914 Southeastern Pkwy
Ste 201
Fishers, IN 46037
Phone (317) 275-1999

8450 Northwest Blvd
Indianapolis, IN 46278

8820 S Meridian St
Ste 235
Indianapolis, IN 46217
Phone (317) 859-1048

8501 Harcourt Rd
Indianapolis, IN 46260
Phone (317) 471-4339

1791 W Lincoln Rd
Kokomo, IN 46902
Phone (574) 753-7600

3903 S 7th St
Ste 2A
Terre Haute, IN 47802
Phone (812) 478-9845

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1423526400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711929600000",
    "number": "1740671999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5765 ORIOLE CT",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452273536",
            "telephone_number": "513-240-1483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8501 HARCOURT RD",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462602046",
            "telephone_number": "317-875-9105",
            "fax_number": "317-808-8802"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "AUDREY",
        "middle_name": "MARIE",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-02-10",
        "last_updated": "2024-04-01",
        "certification_date": "2024-04-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225X00000X",
            "taxonomy_group": "",
            "desc": "Occupational Therapist",
            "state": "IN",
            "license": "31005824A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Indianapolis, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 1, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.