Colleen Rae Black, MSN RNP CNM RN NP

Primary specialty

Advanced Practice MidwifeTaxonomy code 367A00000X

License

1129 Issued in CA

Practice address

2823 Fresno St
Fresno, CA 93721-1324

Phone

(559) 499-6540

Fax

(559) 499-6541

NPI assigned

Nov 23, 2005

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 3

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in CA2 enrollments

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Certified Nurse Midwife, Master of Science - Nursing, Nurse Practitioner, Registered Nurse

State licenses

Practice roles

Locations (25 of 28)

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/CCECCA

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.

• Central California Faculty Medical Group, Inc.

  • Emergency Medicine Physician
  • Fresno, CA
  • NPI 1457603573

  CA

  Medicare reassignment NPD
• County of Tulare

  • Community/Behavioral Health Agency
  • Visalia, CA
  • NPI 1407304678

  CA

  Medicare reassignment NPD
• Family Healthcare Network

  • Federally Qualified Health Center (FQHC)
  • Woodlake, CA
  • NPI 1164517744

  CA

  Medicare reassignment NPD
• Permanente Medical Group Inc

  • Internal Medicine Physician
  • Santa Clara, CA
  • NPI 1073606299

  CA, Obstetrics & Gynecology

  Medicare reassignment NPD
• University Faculty Associates, Inc.

  • Internal Medicine Physician
  • Fresno, CA
  • NPI 1073911137

  CA, Obstetrics & Gynecology

  Medicare reassignment NPD
• Obhg California, P.C.

  • Obstetrics & Gynecology Physician
  • Greenville, SC
  • NPI 1215258892

  CA, Obstetrics & Gynecology

  Medicare reassignment NPD
• Central California Faculty Medical Group, Inc.

  • Internal Medicine Physician
  • Clovis, CA
  • NPI 1992742852

  Obstetrics & Gynecology

  NPD
• County of Tulare

  • Federally Qualified Health Center (FQHC)
  • Visalia, CA
  • NPI 1457385163
  NPD
• County of Tulare

  • Community/Behavioral Health Agency
  • Porterville, CA
  • NPI 1518418581
  NPD
• Family Healthcare Network

  • Federally Qualified Health Center (FQHC)
  • Pixley, CA
  • NPI 1033661558
  NPD
• Family Healthcare Network

  • Federally Qualified Health Center (FQHC)
  • Porterville, CA
  • NPI 1053875484
  NPD
• Family Healthcare Network

  • Federally Qualified Health Center (FQHC)
  • Delano, CA
  • NPI 1063283158
  NPD

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

{
    "created_epoch": "1132704000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1640736000000",
    "number": "1801879879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2625 E DIVISADERO ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937211431",
            "telephone_number": "559-443-2682",
            "fax_number": "559-443-2681"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2823 FRESNO ST",
            "city": "FRESNO",
            "state": "CA",
            "postal_code": "937211324",
            "telephone_number": "559-499-6540",
            "fax_number": "559-499-6541"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2823 Fresno St",
            "address_purpose": "LOCATION",
            "city": "Fresno",
            "state": "CA",
            "postal_code": "937211324",
            "country_code": "US",
            "telephone_number": "559-499-6540",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "COLLEEN",
        "middle_name": "RAE",
        "name_prefix": "Ms.",
        "credential": "MSN RNP CNM RN NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2005-11-23",
        "last_updated": "2021-12-29",
        "certification_date": "2020-10-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "6558",
            "primary": false
        },
        {
            "code": "367A00000X",
            "taxonomy_group": "",
            "desc": "Advanced Practice Midwife",
            "state": "CA",
            "license": "1129",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGISTERED NURSE",
            "identifier": "449993",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE PRACTITIONER",
            "identifier": "6558",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NURSE MIDWIFE",
            "identifier": "1129",
            "state": "CA"
        }
    ],
    "endpoints": [
        {
            "endpointType": "SOAP",
            "endpointTypeDescription": "SOAP URL",
            "endpoint": "https://careepicwest.kp.org:14430/Interconnect-prodcalgateway/wcf/epic.community.hie/xcpdrespondinggatewaysync.svc/ncalceq",
            "affiliation": "Y",
            "endpointDescription": "Carequality",
            "affiliationName": "The Permanente Medical Group",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "C-CDA",
            "address_1": "7300 N Fresno St",
            "city": "Fresno",
            "state": "CA",
            "country_code": "US",
            "postal_code": "937202941",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• BK Pharmacy Corp
• BK Pharmacy Corp
• Black Enterprises Healthcare Management, Inc
• Black Wellness & Prosperity Center
• Ariel Lynnice Black-Gray
• Danell Tenyenhuis Black, LPCC
• Desari M Black, SUDCCIII-CS
• Marcelia Ann Black, LCSW
• Megan Black
• Nicholas Dean Black, MD

• All providers in Fresno, CA
• Advanced Practice Midwife in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2021; 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.