Individual provider Active NPI

Heather Wynne Black, NP

  • Family Nurse Practitioner
  • New Bern, NC
National Provider Identifier
1851717573
Registry record updated Jan 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
5006809 Issued in NC
Practice address
670 Cardinal Rd
New Bern, NC 28562-5201
Phone
(252) 636-6222
Fax
(252) 636-5385
NPI assigned
Mar 6, 2014
Last updated
Jan 12, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2022

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 5006809 NC Primary

Addresses

Primary practice location

670 Cardinal Rd
New Bern, NC 28562-5201

Mailing address

PO Box 12248
New Bern, NC 28561-2248
Phone (252) 636-6222

Other names 1

  • Heather Faith Wynne Former name

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address hblack110532@direct.vidanthealth.com

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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 1

Enrollment IDStateProvider typePAC IDDetails
I20140730000905 NC Practitioner - Nurse Practitioner 0345466231 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Vidant Medical Group LLCGroup PAC ID 0345343893, 986 clinicians

Practice addresses (Care Compare)

740 Bragaw LN
Chocowinity, NC 27817-8415
Phone (252) 946-9562

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
96.95 of 100Reported as apm
Quality
82.44
Promoting interoperability
100
Improvement activities
40

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Vidant Medical Group LLC CurrentSince Oct 1, 2016 Accepting new patients

Locations

740 Bragaw Ln
Chocowinity, NC 27817
Phone (252) 946-9562

2100 Stantonsburg Rd
Greenville, NC 27834
Phone (252) 744-3229

401 N Main St
Kenansville, NC 28349
Phone (910) 296-0941

Interoperability endpoints

  • Direct secure messaging: hblack110532@direct.vidanthealth.com

Organizations & group practices 1

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.

Hospital & facility affiliations 2

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": "1394064000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1641945600000",
    "number": "1851717573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 12248",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "285612248",
            "telephone_number": "252-636-6222",
            "fax_number": "252-636-5385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "670 CARDINAL RD",
            "city": "NEW BERN",
            "state": "NC",
            "postal_code": "285625201",
            "telephone_number": "252-636-6222",
            "fax_number": "252-636-5385"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "HEATHER",
        "middle_name": "WYNNE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-03-06",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5006809",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "hblack110532@direct.vidanthealth.com",
            "affiliation": "N",
            "address_1": "2100 Stantonsburg Rd",
            "city": "Greenville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "278342818",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "HEATHER",
            "last_name": "WYNNE",
            "middle_name": "FAITH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in New Bern, NC

Sources for this page

Verify at the official NPI Registry.