NPIMap

Individual provider Active NPI

Jason W Black, M.D.

  • Geriatric Medicine (Family Medicine) Physician
  • Baltimore, MD
National Provider Identifier
1245259902
Registry record updated Dec 21, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Geriatric Medicine (Family Medicine) PhysicianTaxonomy code 207QG0300X
License
D61199 Issued in MD
Practice address
6701 N Charles St
Ste 4105
Baltimore, MD 21204-6808
Phone
(443) 849-3184
NPI assigned
Jul 19, 2006
Last updated
Dec 21, 2011By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 21, 2011

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X D61199 MD
Geriatric Medicine (Family Medicine) Physician 207QG0300X D61199 MD Primary

Addresses

Primary practice location

6701 N Charles St
Ste 4105
Baltimore, MD 21204-6808

Mailing address

PO Box 41895
Boston, MA 02241-8953

Other identifiers 3

IdentifierTypeStateIssuer
405540300MedicaidMD
KJ15/64265301OtherMDCAREFIRST MARYLAND GBMC
S1380079OtherMDCAREFIRST REGIONAL GBMC

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MD
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
I20041027000778 MD Practitioner - Geriatric MedicinePractitioner - Family PracticePractitioner - Hospice/Palliative Care 2264494749 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Geriatric MedicineAlso: Family Practice, Hospice/Palliative Care
Education
University of California, Davis School of Medicine, 1996
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Gilchrist Hospice Care IncGroup PAC ID 2769580422, 52 clinicians

Practice addresses (Care Compare)

6701 N Charles St
4105 Gilchrist Elder Medical Care
Gilchrist Elder Medical C, MD 21204-6808
Phone (443) 849-3184

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
D61199MDMDGeriatric Medicine (Family Medicine) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Greater Baltimore Medical Center, Inc. CurrentSince Nov 1, 2010 Accepting new patients
Greater Baltimore Medical Center, Inc. CurrentSince Nov 1, 2010 Accepting new patients
Gilchrist Hospice Care, Inc. CurrentSince Jul 1, 2019 Accepting new patients
Gilchrist Hospice Care, Inc. CurrentSince Jul 1, 2019 Accepting new patients
Greater Baltimore Medical Center, Inc Current Accepting new patients
The Grand Lodge of Ancient Free and Accepted Masons of Maryland Past Accepting new patients
Keswick Multi-Care Center Inc Past Accepting new patients

Locations

6565 N Charles St
Ste 203
Towson, MD 21204
Phone (410) 828-3760

6569 N Charles St
Ste 307
Towson, MD 21204
Phone (443) 849-2767

6569 N Charles St
Ste 505
Towson, MD 21204
Phone (443) 849-2196

6701 N Charles St
Ste 4105
Towson, MD 21204
Phone (443) 849-3184

Interoperability endpoints

  • Direct secure messaging: jblack8218@gbmcdirect.org

Organizations & group practices 7

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 9

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": "1153267200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1324425600000",
    "number": "1245259902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 41895",
            "city": "BOSTON",
            "state": "MA",
            "postal_code": "022418953"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6701 N CHARLES ST",
            "address_2": "STE 4105",
            "city": "BALTIMORE",
            "state": "MD",
            "postal_code": "212046808",
            "telephone_number": "443-849-3184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "JASON",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-19",
        "last_updated": "2011-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MD",
            "license": "D61199",
            "primary": false
        },
        {
            "code": "207QG0300X",
            "taxonomy_group": "",
            "desc": "Family Medicine, Geriatric Medicine",
            "state": "MD",
            "license": "D61199",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "405540300",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST MARYLAND GBMC",
            "identifier": "KJ15/64265301",
            "state": "MD"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAREFIRST REGIONAL GBMC",
            "identifier": "S1380079",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Baltimore, MD

Sources for this page

Verify at the official NPI Registry.