Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mr. Timothy Black, PA

Individual provider Physician Assistant · NPI 1730167271

Mr. Timothy Black, PA is a Physician Assistant in Vancouver, Washington. Qualified in 1993, 33 years ago. Practices with Northwest Surgical Specialists PC, a 117-clinician group and accepts Medicare assignment. Licensed in Washington.

Years since qualifying
33
Licensed in
WA
In the registry since
2006
Specialties on file
2
What do these letters mean?
PA — Physician Assistant
A licensed clinician who examines, diagnoses and treats under a physician's supervision.

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Practice location Address checks out

200 NE Mother Joseph Pl Ste 110
Vancouver, WA 98664
Phone: (360) 254-6161
Fax: (360) 449-1146
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Surgical Physician Assistant (primary) Taxonomy 363AS0400X (WA)
Physician Assistant Taxonomy 363A00000X · Licence PA60650228 (WA)

Record details

NPI number1730167271
Entity typeIndividual (Type 1)
GenderMale
Credentials PA
Sole proprietorNo
NPI enumeratedJanuary 5, 2006
Last updated in NPPESAugust 7, 2018
Mailing address200 Ne Mother Joseph Pl Ste 210, Vancouver, WA 98664-3295

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 1993 (33 years in practice)
Group practice Northwest Surgical Specialists Pc — 117 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations5 on file with Medicare

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