Active NPI
Suzanne Black, RDN
- Registered Dietitian
- Portland, OR
National Provider Identifier
1760980874
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Dietitian
- License
- LD-D-000313
- Practice address
- 5211 NE Glisan St BLDG C
Portland, OR 97213-3052 - Phone
- (503) 215-6628
- NPI assigned
- Jan 24, 2018
- Last updated
- Apr 3, 2019
- 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 | LD-D-000313 | OR | Primary |
Addresses
Primary practice location
5211 NE Glisan St BLDG C
Portland, OR 97213-3052
Mailing address
PO Box 3158
Portland, OR 97208-3158
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LD-D-000313 | OR | MD | Registered Dietitian |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1516752000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554249600000",
"number": "1760980874",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 3158",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972083158"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5211 NE GLISAN ST BLDG C",
"city": "PORTLAND",
"state": "OR",
"postal_code": "972133052",
"telephone_number": "503-215-6628"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "SUZANNE",
"credential": "RDN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-01-24",
"last_updated": "2019-04-03",
"status": "A"
},
"taxonomies": [
{
"code": "133V00000X",
"taxonomy_group": "",
"desc": "Dietitian, Registered",
"state": "OR",
"license": "LD-D-000313",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.