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MR. TIMOTHY BLACK PA
NPI 1730167271
Physician Assistant - Surgical in Vancouver, WA

Active since January 05, 2006PECOS EnrolledAccepts Medicare Assignment
100/100
CMS Quality Rating
200 NE MOTHER JOSEPH PL, SUITE 110, VANCOUVER, WA 98664(360) 254-6161(360) 449-1146 Get Directions Write a Review

NPPES record last updated: August 7, 2018. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Aug 7, 2018, Aug 23, 2016 (2 updates tracked since 2016).

About Mr. Timothy Black Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. TIMOTHY BLACK PA (NPI 1730167271) is an individual surgical provider in Vancouver, Washington and active in the NPI registry since January 2006. He is enrolled in Medicare PECOS, is affiliated with Peacehealth Southwest Medical Center, and is a graduate of Other (1993).

NPPES Registry Identity

NPI1730167271
Entity TypeIndividualMale
Primary Taxonomy363AS0400X
Provider Legal NameMR. TIMOTHY BLACKCredential: PA
Location Address200 NE MOTHER JOSEPH PL, SUITE 110Vancouver, WA 98664
Mailing Address200 Ne Mother Joseph Pl Ste 210Vancouver, WA 98664-3295 · (360) 254-6161 · Fax (360) 449-1146
Phone(360) 254-6161
Fax(360) 449-1146
Sole ProprietorNo
Medical School CMSOtherGraduated 1993
Enumeration DateJanuary 5, 2006
Last NPPES UpdateAugust 7, 20182 updates tracked since enumeration
✔ NPI 1730167271 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPhysician Assistant · SurgicalPhysician Assistants & Advanced Practice Nursing Providers
Taxonomy Code363AS0400X
Also ListedPhysician AssistantTaxonomy 363A00000X · License PA60650228 (WA)
200 NE MOTHER JOSEPH PL, Vancouver, WA 98664
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Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include BridgeSpan Health Company, Kaiser Permanente, Moda Health Plan, Inc. and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mr. Timothy Black Pa is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4284725292
PECOS Enrollment IDI20160916000907, I20160919001707
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 8

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

X-ray of shoulder, minimum of 2 views 73030
An X-ray of the shoulder, with a minimum of 2 views, is a non-invasive imaging test. It uses a small amount of radiation to produce images of your shoulder bones. This helps in diagnosing conditions like fractures, arthritis, or other abnormalities. The procedure is quick and painless.
137 services97 patients
Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
74 services60 patients
Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214
This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.
58 services48 patients
Aspiration and/or injection of fluid from large joint 20610
This procedure involves using a needle to remove (aspiration) or introduce (injection) fluid into a large joint like the knee or hip. It can help diagnose conditions, relieve discomfort, or deliver medication directly to the joint.
34 services28 patients
New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more 99204
This is a first-time office or outpatient visit lasting between 45-59 minutes. The healthcare provider evaluates your health, discusses your medical history, and may suggest further tests or treatments. It's an opportunity to ask questions and understand your health better.
28 services28 patients
Prosthetic repair of shoulder joint, total shoulder 23472
Total shoulder prosthetic repair is a surgical procedure to replace a damaged shoulder joint with artificial components. It aims to relieve pain and restore mobility. The procedure involves replacing the ball (humeral head) and socket (glenoid) of the shoulder joint.
27 services27 patients

Hospital Affiliations CMS Care Compare 2

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Peacehealth Southwest Medical Center

Acute Care Hospitals · Vancouver, WA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number500050
Location400 NE Mother Joseph PlaceVancouver, WA 98668 · Clark County
Emergency services Birthing friendly

Legacy Salmon Creek Medical Center

Acute Care Hospitals · Vancouver, WA
4/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number500150
Location2211 NE 139th StreetVancouver, WA 98686 · Clark County
Emergency services Birthing friendly

Medicare Quality Performance CMS QPP · MIPS

Performance in the CMS Quality Payment Program: the MIPS final score across four weighted categories, and the individual quality measures reported to Medicare.

100/100
MIPS Final ScoreMerit-based Incentive Payment System · CMS Quality Payment Program
Scored as part of a group practice
Promoting Interoperability100
Improvement Activities40

Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

NORMAN C. ROKOSZ M.D.
Neurological Surgery
200 NE MOTHER JOSEPH PL, SUITE 110
VANCOUVER, WA 98664
Clark County (360) 254-6161
EDWARD H. COALE M.D.
Orthopaedic Surgery (Hand Surgery)
200 NE MOTHER JOSEPH PL, SUITE 110
VANCOUVER, WA 98664
Clark County (360) 254-6161
JAMES WEBSTER PT
Physical Therapist
200 NE MOTHER JOSEPH PL, SUITE 210
VANCOUVER, WA 98664
Clark County (360) 254-6161
ALAN P. NEWMAN M.D.
Orthopaedic Surgery
200 NE MOTHER JOSEPH PL, SUITE 110
VANCOUVER, WA 98664
Clark County (360) 254-6161
EDWARD A. SPARLING M.D.
Orthopaedic Surgery
200 NE MOTHER JOSEPH PL, SUITE 110
VANCOUVER, WA 98664
Clark County (360) 254-6161
PHILLIP A RUFF MPT, CHT
Physical Therapist (Hand)
200 NE MOTHER JOSEPH PL, SUITE 110
VANCOUVER, WA 98664
Clark County (360) 254-6161
NATALIE E BOODIN M.D.
Physical Medicine & Rehabilitation
200 NE MOTHER JOSEPH PL, #100
VANCOUVER, WA 98664
Clark County (360) 514-3142
EDGAR K. RAGSDALE M.D.
Orthopaedic Surgery
200 NE MOTHER JOSEPH PL, SUITE 110
VANCOUVER, WA 98664
Clark County (360) 254-6161

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Timothy Black's NPI number?

The NPI number for Timothy Black is 1730167271. It was assigned to this individual provider in the NPPES registry on January 5, 2006.

Where is Timothy Black located?

Timothy Black practices at 200 NE Mother Joseph Pl Suite 110, Vancouver, WA 98664. The listed phone number is (360) 254-6161.

What is Timothy Black's specialty?

The primary specialty registered for this NPI is Physician Assistant, specializing in Surgical, with taxonomy code 363AS0400X.

Is Timothy Black enrolled in Medicare?

Yes. Timothy Black is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Timothy Black accept?

Health plans from BridgeSpan Health Company, Kaiser Permanente, Moda Health Plan, Inc., PacificSource Health Plans and Providence Health Plan and 1 other insurer list Timothy Black as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

Is Timothy Black affiliated with any hospitals?

According to CMS data, Timothy Black is affiliated with Peacehealth Southwest Medical Center and Legacy Salmon Creek Medical Center.

When was this NPI record last updated?

The NPPES record for Timothy Black was last updated on August 7, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.