NPIMap

Individual provider Active NPI

Katherine Rollins Black, MD

  • Gastroenterology Physician
  • Portland, OR
National Provider Identifier
1801018122
Registry record updated Mar 21, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Gastroenterology PhysicianTaxonomy code 207RG0100X
License
MD156824 Issued in OR
Practice address
1130 NW 22ND Ave Ste 410
Portland, OR 97210-2911
Phone
(503) 229-7137
Fax
(503) 241-0628
NPI assigned
May 3, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 21, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Gastroenterology Physician 207RG0100X MD156824 OR Primary

Addresses

Primary practice location

1130 NW 22ND Ave Ste 410
Portland, OR 97210-2911

Mailing address

1130 NW 22ND Ave Ste 410
Portland, OR 97210-2911
Phone (503) 229-7137

Other identifiers 2

IdentifierTypeStateIssuer
500647193MedicaidOR
MD156824OtherORPROVIDER STATE LICENSE

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20120823000132 OR Practitioner - GastroenterologyPractitioner - Internal Medicine 6002063211 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
GastroenterologyAlso: Internal Medicine
Education
University of South Carolina School of Medicine, 2012
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Northwest Gastroenterology Clinic LLCGroup PAC ID 7315935897, 13 clinicians

Practice addresses (Care Compare)

1130 NW 22ND Ave
Suite 410
Portland, OR 97210-2911
Phone (503) 229-7137

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
88.8 of 100Reported as group
Quality
83.56
Promoting interoperability
100
Improvement activities
40
Cost
76.68

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy37
Upper gastrointestinal (GI) endoscopy for acid reflux43

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Northwest Gastroenterology Clinic LLC CurrentSince Aug 1, 2012 Accepting new patients
NGC Endoscopy Services LLC Current Accepting new patients

Locations

1130 NW 22nd Ave
Ste 410
Portland, OR 97210
Phone (503) 229-7137

1130 NW 22nd Ave
Ste 615
Portland, OR 97210
Phone (503) 229-7137

Interoperability endpoints

  • Direct secure messaging: kblack71013@direct.lhs.org

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1178150400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363824000000",
    "number": "1801018122",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1130 NW 22ND AVE STE 410",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102911",
            "telephone_number": "503-229-7137",
            "fax_number": "503-241-0628"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1130 NW 22ND AVE STE 410",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972102911",
            "telephone_number": "503-229-7137",
            "fax_number": "503-241-0628"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "KATHERINE",
        "middle_name": "ROLLINS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-03",
        "last_updated": "2013-03-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RG0100X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Gastroenterology",
            "state": "OR",
            "license": "MD156824",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "500647193",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER STATE LICENSE",
            "identifier": "MD156824",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Portland, OR

Sources for this page

Verify at the official NPI Registry.