Catherine C Black, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA10004690 Issued in WA

Practice address

212 E Central Ave Ste 240
Spokane, WA 99208-6597

Phone

(509) 455-8820

NPI assigned

Jun 30, 2006

Last updated

Oct 21, 2024By 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 5

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

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

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

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

{
    "created_epoch": "1151625600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1729468800000",
    "number": "1780613018",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 331",
            "city": "LIBERTY LAKE",
            "state": "WA",
            "postal_code": "990190331",
            "telephone_number": "866-747-2455",
            "fax_number": "509-944-9644"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "212 E CENTRAL AVE STE 240",
            "city": "SPOKANE",
            "state": "WA",
            "postal_code": "992086597",
            "telephone_number": "509-455-8820"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "808 Port Dr",
            "address_purpose": "LOCATION",
            "city": "Clarkston",
            "state": "WA",
            "postal_code": "994036009",
            "country_code": "US",
            "telephone_number": "509-455-8820",
            "fax_number": "509-838-4978",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "CATHERINE",
        "middle_name": "C",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-30",
        "last_updated": "2024-10-21",
        "certification_date": "2024-10-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA159129",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "7072",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10004690",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "WA",
            "license": "PA10004690",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "WA",
            "license": "PA10004690",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8415937",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "L&I",
            "identifier": "0194214",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500648665",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Matthew Bitz
• Hailey Bjerkestrand, PA -C
• Benjamin Bjorgaard, LMFT,LPC,LMHC,LPCC
• Black Liberation and Community Care, PLLC (Blacc)
• Carolyn Black, MD
• Dianna Laura Black, CHW
• Jeniffer Black
• Kiersten Black
• Nancy Lorraine Black, PT
• Aryanna Joy Blackburn

• Physician Assistant in Spokane, WA
• Providers in Spokane, WA by specialty
• Physician Assistant in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2024; 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.