Jerrold G Black, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

01063821A Issued in IN

Practice address

4167 Merchant PLZ
Woodbridge, VA 22192-5088

Phone

(703) 878-8800

Fax

(703) 878-2133

NPI assigned

Aug 2, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in VA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

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

• Virginia Urgent Care LLC

  • Urgent Care Clinic/Center
  • Fredericksburg, VA
  • NPI 1487838652
  Medicare reassignment NPD

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

{
    "created_epoch": "1154476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1298851200000",
    "number": "1104833904",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4167 MERCHANT PLZ",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221925088",
            "telephone_number": "703-878-8800",
            "fax_number": "703-878-2133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4167 MERCHANT PLZ",
            "city": "WOODBRIDGE",
            "state": "VA",
            "postal_code": "221925088",
            "telephone_number": "703-878-8800",
            "fax_number": "703-878-2133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "JERROLD",
        "middle_name": "G",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-02",
        "last_updated": "2011-02-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "IN",
            "license": "01063821A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104833904",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ojasbi Bishwakarma
• Bismark Transportation Service LLC
• BJ'S Wholesale Club Inc.
• Amy Black, IBCLC
• Bruce Ellis Black II
• Eric Blackstone, DPT
• Debbie June Blackwell
• Kristy A Blair, D.P.T
• Diana D Blandon, MSW,QMHP
• Blessed Healthcare Professionals, Inc

• Family Medicine Physician in Woodbridge, VA
• Providers in Woodbridge, VA by specialty
• Family Medicine Physician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.