Active NPI
Abby Black, RD, CDE
- Registered Dietitian
- Saint Joseph, MI
National Provider Identifier
1750631511
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- 875262
- Practice address
- 511 Renaissance Dr
Suite 130
Saint Joseph, MI 49085-2180 - Phone
- (269) 350-9789
- NPI assigned
- Sep 19, 2012
- Last updated
- Oct 31, 2016
- 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 |
|---|---|---|---|---|
| Registered Dietitian | 133V00000X | 875262 | NU | Primary |
Addresses
Primary practice location
511 Renaissance Dr
Suite 130
Saint Joseph, MI 49085-2180
Mailing address
717 Saint Joseph Dr
Ste 140
Saint Joseph, MI 49085-2428
Phone (269) 369-2347
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Fay Nutrition | Dietitian, Registered | Past | Accepting new patients |
| Nourish, Inc. | Dietitian, Registered | Past | Accepting new patients |
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Registered Dietitian
- Saint Joseph, MI
- NPI 1811247679
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1348012800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1477872000000",
"number": "1750631511",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "717 SAINT JOSEPH DR",
"address_2": "STE 140",
"city": "SAINT JOSEPH",
"state": "MI",
"postal_code": "490852428",
"telephone_number": "269-369-2347"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "511 RENAISSANCE DR",
"address_2": "SUITE 130",
"city": "SAINT JOSEPH",
"state": "MI",
"postal_code": "490852180",
"telephone_number": "269-350-9789"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "ABBY",
"name_prefix": "Mrs.",
"credential": "RD, CDE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-09-19",
"last_updated": "2016-10-31",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "NU",
"license": "875262",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saint Joseph, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.