NPIMap

Individual provider Active NPI

John William Black, M.D.

  • Diagnostic Radiology Physician
  • Charlotte, NC
National Provider Identifier
1023092095
Registry record updated Sep 13, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
96-01000 Issued in NC
Practice address
3623 Latrobe Dr
Suite 216
Charlotte, NC 28211
Phone
(704) 332-1291
Fax
(704) 332-5206
NPI assigned
Dec 2, 2005
Last updated
Sep 13, 2020By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 13, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 27821 SC
Diagnostic Radiology Physician 2085R0202X 96-01000 NC Primary

Addresses

Primary practice location

3623 Latrobe Dr
Suite 216
Charlotte, NC 28211

Mailing address

PO Box 221249
Charlotte, NC 28222-1249
Phone (704) 332-1291

Other identifiers 1

IdentifierTypeStateIssuer
891010RMedicaidNC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20041006000565 NC Practitioner - Diagnostic Radiology 6103895479 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Georgetown University School of Medicine, 1990
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Mecklenburg Radiology Associates PAGroup PAC ID 6800789587, 95 clinicians

Practice addresses (Care Compare)

3623 Latrobe Dr
Suite 216
Charlotte, NC 28211-2117
Phone (704) 332-1291

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
91.03 of 100Reported as group
Quality
98.89
Improvement activities
40
Cost
72.14

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
96-01000NCMDDiagnostic Radiology Physician
27821SCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Mecklenburg Diagnostic Imaging LLC Diagnostic Radiology CurrentSince Sep 1, 2009 Accepting new patients
Presbyterian Imaging Centers LLC Diagnostic Radiology CurrentSince Jul 1, 1996 Accepting new patients
Presbyterian Imaging Centers LLC Diagnostic Radiology CurrentSince Jul 1, 1996 Accepting new patients
Mecklenburg Diagnostic Imaging LLC Diagnostic Radiology CurrentSince Sep 1, 2009 Accepting new patients
Mecklenburg Radiology Associates, P.a. Diagnostic Radiology CurrentSince Jul 3, 1996 Accepting new patients
Presbyterian Breast Center LLC Diagnostic Radiology CurrentSince Nov 1, 2004 Accepting new patients
Mecklenburg Diagnostic Imaging LLC Diagnostic Radiology CurrentSince Sep 1, 2009 Accepting new patients
Presbyterian Breast Center LLC Diagnostic Radiology CurrentSince Apr 1, 2022 Accepting new patients
Presbyterian Imaging Centers LLC Diagnostic Radiology CurrentSince Dec 4, 2018 Accepting new patients
Mooresville Hospital Management Associates LLC Past Accepting new patients
Mooresville Hospital Management Associates, LLC Past Accepting new patients

Locations

3623 Latrobe Dr
Ste 216
Charlotte, NC 28211
Phone (704) 926-1827

6324 Fairview Rd
Ste 120
Charlotte, NC 28210
Phone (704) 362-8444

171 Fairview Rd
Mooresville, NC 28117
Phone (704) 660-4000

Organizations & group practices 11

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 8

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1133481600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1599955200000",
    "number": "1023092095",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 221249",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282221249",
            "telephone_number": "704-332-1291",
            "fax_number": "704-332-5206"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3623 LATROBE DR",
            "address_2": "SUITE 216",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "28211",
            "telephone_number": "704-332-1291",
            "fax_number": "704-332-5206"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "JOHN",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-02",
        "last_updated": "2020-09-13",
        "certification_date": "2020-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "SC",
            "license": "27821",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "96-01000",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "891010R",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlotte, NC

Sources for this page

Verify at the official NPI Registry.