Mike A Black, CEPS, NREMT

Primary specialty

Clinical Cardiac Electrophysiology PhysicianTaxonomy code 207RC0001X

License

161255 Issued in DC

Practice address

4989 S State St Unit 57768
Salt Lake City, UT 84157-5032

Phone

(916) 217-1584

Fax

(866) 722-1584

NPI assigned

Dec 28, 2017

Last updated

May 3, 2019By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1514419200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1556841600000",
    "number": "1942716998",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 57768",
            "city": "MURRAY",
            "state": "UT",
            "postal_code": "841570768",
            "telephone_number": "916-217-1584",
            "fax_number": "866-722-1584"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4989 S STATE ST UNIT 57768",
            "city": "SALT LAKE CITY",
            "state": "UT",
            "postal_code": "841575032",
            "telephone_number": "916-217-1584",
            "fax_number": "866-722-1584"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "MIKE",
        "middle_name": "A",
        "credential": "CEPS, NREMT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-12-28",
        "last_updated": "2019-05-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "146N00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medical Technician, Basic",
            "state": "NU",
            "license": "E1160515",
            "primary": false
        },
        {
            "code": "207RC0001X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Clinical Cardiac Electrophysiology",
            "state": "DC",
            "license": "161255",
            "primary": true
        },
        {
            "code": "246W00000X",
            "taxonomy_group": "",
            "desc": "Technician, Cardiology",
            "state": "WA",
            "license": "60434882",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jerry Beck Black, D.D.S.
• Karen Sasaki Black, MD
• Kathryn Olivia Black
• Kristen Black, DPT
• Madison T. Black, MD, MPH
• Pamella Black, AUD
• Richard E Black, MD
• Romney Richard Black, D.D.S.
• Sarah A Black, LCSW
• William Black, RPH

• Clinical Cardiac Electrophysiology Physician in Salt Lake City, UT
• Providers in Salt Lake City, UT by specialty
• Clinical Cardiac Electrophysiology Physician in Utah

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

Verify at the official NPI Registry.