MARISSA BLACK (M.D.) – Geriatric Medicine (Internal Medicine) Physician, NPI 1114269735
Geriatric Medicine (Internal Medicine) Physician
Main info
Doctor Profile
Profile Insights
NPPES metrics only — not quality of care.
107 GERIATRIC MEDICINE in WA
Provider Addresses for MARISSA BLACK (M.D.)
11521 NE 128TH ST STE 100
KIRKLAND, WA 980344317
Phone: (425) 899-6800
Fax: (425) 899-6818
Type: Mailing
325 9th Ave
Box 359755, Rm. 5048 PSB
Seattle, WA 981042420
Phone: (206) 744-9102
Fax: (206) 744-9976
Type: Location
1660 S Columbian Way
Seattle, WA 981081532
Phone: (206) 762-1010
Type: Location
11521 NE 128th St Ste 100
Kirkland, WA 98034
Phone: (425) 899-6800
Fax: (425) 899-6818
Type: Location
NPPES updates history
No NPPES updates recorded for this provider.
Prescription Activity
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Open Payments (CMS)
No Open Payments data available for this provider.
This can happen when there are no reportable CMS Open Payments records.
Medicare Enrollment & Revalidation
Source: CMS public data · Not endorsed by CMS ·
Educational use only—not medical, billing, or legal advice.
PECOS enrollment status
Participating (accepts Medicare assignment)
Enrollment effective: 2017-01-19
PECOS data refreshed: 2026-05-27
Medicare revalidation (CMS due date list)
Due date not assigned yet
CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.
Enrollment records
1
Earliest due date
Not assigned (TBD)
CMS data updated
2026-06-01
Revalidation progress
- Medicare enrolled
- On CMS revalidation list
- Due date assigned
- Revalidate in PECOS
CMS enrollment records
| Enrollment ID | Type | Specialty | State | Due date |
|---|---|---|---|---|
| I20170119002104 | I | Geriatric Medicine | WA | TBD |
What to do next
- No action required while the due date shows TBD.
- Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
- Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.
Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS
Medicare Utilization (FFS)
Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·
Educational use only—not medical, billing, or legal advice.
Top Medicare procedures (2023) · refreshed 2026-05-27
| HCPCS | Description | Services | Beneficiaries | Medicare allowed |
|---|---|---|---|---|
| 99215 | Established patient office or other outpatient visit, 40-54 minutes | 441 | 198 | $0 |
| 99214 | Established patient office or other outpatient visit, 30-39 minutes | 112 | 83 | $0 |
| G0439 | Annual wellness visit, includes a personalized prevention plan of service (pps), subsequent visit | 38 | 38 | $0 |
| 99497 | Advance care planning, first 30 minutes | 31 | 30 | $0 |
| G2212 | Prolonged office or other outpatient evaluation and management service(s) beyond the maximum required time of the primary procedure which has been selected using total time on the date of the primary service; each additional 15 minutes by the physician or | 30 | 18 | $0 |
Insurance plans in this area (ZIP 98034)
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Group practice members
| Name | Specialty | State |
|---|---|---|
| Internal Medicine | MA | |
| Internal Medicine | VA | |
| Family Practice | GA | |
| Orthopedic Surgery | IL | |
| - | NC | |
| - | TX | |
| Internal Medicine | MA | |
| Family Practice | OR | |
| Nurse Practitioner | WA | |
| Internal Medicine | MA |
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