DR. MARY E BLACK (NPI# 1417375510) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1417375510 |
| Entity Type | Individual |
| Full Name | DR. MARY E BLACK |
| Credential | MD |
| Practice Address |
825 E Rundberg Ln Ste B1 Austin TX 78753-4860 |
| Practice Telephone | 5129789600 |
| Practice Fax Number | 5129019771 |
| Mailing Telephone | 5129789600 |
| Mailing Fax Number | 5129019771 |
| Enumeration Date | 2014-04-04 |
| Last Update Date | 2018-10-08 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | TEMPORARY | TX | Allopathic & Osteopathic Physicians |
| N | 207Q00000X | Family Medicine | 131116 | FL | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356813984 | Mary Ann Black | Registered Nurse | 1334 Dallas Ave, Winter Park, FL 32789-3641 | 2018-12-20 |
| 1679051668 | Mary Elizabeth Black | Nurse Practitioner | 222 Dave Ward Drive, Conway, AR 72032 | 2018-08-01 |
| 1750823456 | Mary Black | Case Manager/Care Coordinator | 1427 Oakland St, Saint Clair, MI 48079-5122 | 2016-11-11 |
| 1730353715 | Mary K Black | Occupational Therapist | 16 Jacobs Mill Ct, Elgin, SC 29045-8646 | 2008-04-21 |
| 1669532107 | Mary Ellen Black | Counselor | 102 East Gambier Street, Mount Vernon, OH 43050 | 2006-12-12 |
| 1407855034 | Mary M Black | Dietitian, Registered | 4300 Fayetteville Rd, Lumberton, NC 28358-2677 | 2005-07-15 |
| 1093289803 | Mary Ward Black | Psychologist | 320 Lester Hall, University, MS 38677 | 2019-01-15 |
| 1760997431 | Mary Black | Registered Nurse | 1058 College Dr, New Town, ND 58763-9112 | 2017-12-04 |
| 1710200233 | Mary Ann Black | Pharmacist | 200 W Belleview Ave, Englewood, CO 80110-6610 | 2010-03-11 |
| 1750573515 | Mary Frances Black | Registered Nurse | 401 E 34th St, Indianapolis, IN 46205-3754 | 2007-08-15 |
| Street Address |
825 E RUNDBERG LN STE B1 |
| City | AUSTIN |
| State | TX |
| Zip Code | 78753-4860 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578508123 | Jose Bayona | Family Medicine | 825 E Rundberg Ln Ste B1, Austin, TX 78753-4860 | 2006-06-18 |
| 1821629817 | Kayla Trevino | Dietitian, Registered | 825 E Rundberg Ln Ste B1, Austin, TX 78753-4860 | 2020-01-29 |
| 1497100275 | Lauren V Vice | Family Medicine | 825 E Rundberg Ln Ste B1, Austin, TX 78753-4860 | 2016-04-28 |
| 1154796019 | Salima Ali | Internal Medicine | 825 E Rundberg Ln Ste B1, Austin, TX 78753-4860 | 2015-12-03 |
| 1730573254 | Griffin Lowe Fuller | Family Medicine | 825 E Rundberg Ln Ste B1, Austin, TX 78753-4860 | 2015-03-23 |
| 1306249818 | Mary Nicole John | Nurse Practitioner | 825 E Rundberg Ln Ste B1, Austin, TX 78753-4860 | 2014-09-29 |
| 1225044589 | Mark Springs | Family Medicine | 825 E Rundberg Ln Ste B1, Austin, TX 78753-4860 | 2006-07-31 |
| 1528099058 | Ana M Avalos Mishaan | Pediatrics | 825 E Rundberg Ln Ste B1, Austin, TX 78753-4860 | 2006-07-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306486659 | Gc Mental Wellness LLC | Counselor | 601 Farley Drive, Austin, TX 78753 | 2020-01-14 |
| 1871142992 | Virgie Lee Clement | Technician | 9704 Kendal Dr, 9704 Kendal Dr, Austin, TX 78753 | 2019-09-11 |
| 1851870190 | Mallory Lynch, Od, Pllc | Optometrist | 500 Canyon Ridge Dr. Suite L300, Austin, TX 78753 | 2018-08-08 |
| 1205320538 | Cameron Health Care LLC | Skilled Nursing Facility | 8324 Cameron Road, Austin, TX 78753 | 2018-06-20 |
| 1851883433 | Greater Austin Transportation Company | Taxi | 10630 Joseph Clayton Dr., Bldg A, Austin, TX 78753 | 2018-05-31 |
| 1093212151 | Enamel Dentistry Parmer Park, Pllc | Dentist | 1606 E. Parmer Ln, Suite #125, Austin, TX 78753 | 2018-04-06 |
| 1699270462 | Kelly Marcello | Nurse Practitioner | 11207 N Lamar Blvd Ste B, Austin, TX 78753 | 2018-03-26 |
| 1710481155 | Techridge Oaks, LLC | Assisted Living Facility | 400 E Yager Ln, Austin, TX 78753 | 2018-03-21 |
| 1013441286 | Mydental At Norwood Pllc | Dentist | 1045 Norwood Park Blvd, Suite 103, Austin, TX 78753 | 2017-04-14 |
| 1477908093 | Nicole Amy Kosich | Massage Therapist | 8740 N. Lamar Blvd., Austin, TX 78753 | 2016-05-02 |
| Find all providers in zip 78753 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1205437662 | Angela Ekern | Family Medicine | 7421 Cordoba Dr, Austin, TX 78724-6252 | 2020-11-03 |
| 1245847011 | Diane Brewer | Family Medicine | 309 Shant St, Austin, TX 78748-1612 | 2020-09-25 |
| 1568075265 | Agno Health, LLP | Family Medicine | 2506 South Lamar Blvd, Unit 2, Austin, TX 78704-4731 | 2020-08-24 |
| 1245853514 | Kaitlin Claire Negandhi Valentine | Family Medicine | 1400 N Ih 35 Ste C2.410, Austin, TX 78701-1926 | 2020-05-21 |
| 1548899248 | Candice Bethke Escobedo | Family Medicine | 12020 Pepperidge Dr, Austin, TX 78739-1948 | 2020-04-04 |
| 1184257123 | Aegis Health Services LLC | Family Medicine | 3005 S Lamar Blvd Ste D109-245, Austin, TX 78704-8864 | 2020-02-18 |
| 1285274100 | Mw Wellness Iv, LLC | Family Medicine | 13359 N Highway 183 Ste 403, Austin, TX 78750-7154 | 2020-01-08 |
| 1578112207 | Heather Lenz | Family Medicine | 6633 E Highway 290 Ste 300, Austin, TX 78723-1158 | 2019-09-05 |
| 1245887355 | Jonathan Thomas Mason | Family Medicine | 1400 N-ih 35, Dell Seton Medical Center, Ste C2.410, Austin, TX 78701 | 2019-08-22 |
| 1609421247 | Maycare, Pllc | Family Medicine | 6911 Ranch Road 620 N Ste A-300, Austin, TX 78732-1920 | 2019-08-08 |
| Find all providers in AUSTIN | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.