Matthew Roger Black

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

5101015934 Issued in MI

Practice address

12500 Willowbrook Rd
Cumberland, MD 21502-6393

Phone

(124) 096-4120

NPI assigned

Nov 13, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

HHS exclusion list flag

Flagged The directory lists this NPI on an HHS exclusion list. Confirm with the OIG exclusions search.

Credentials

Doctor of Medicine

State licenses

Practice roles

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.

• Premier Emergency Physicians of Idaho Medical Group

  • Emergency Medicine Physician
  • Nampa, ID
  • NPI 1942259965
  NPD (past)
• Treasure Valley Emergency Physicians

  • Emergency Medicine Physician
  • Nampa, ID
  • NPI 1053360065
  NPD (past)

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

{
    "created_epoch": "1194912000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1266192000000",
    "number": "1437339900",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20251 CENTURY BLVD STE 130",
            "city": "GERMANTOWN",
            "state": "MD",
            "postal_code": "208741199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12500 WILLOWBROOK RD",
            "city": "CUMBERLAND",
            "state": "MD",
            "postal_code": "215026393",
            "telephone_number": "124-096-4120"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "MATTHEW",
        "middle_name": "ROGER",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-11-13",
        "last_updated": "2010-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MI",
            "license": "5101015934",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MD",
            "license": "HOO69899",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brent Biller, CRNA
• Lauren Taylor Bird, MS, CFY/SLP
• Les Bittinger
• Denise Kim Bittner, CRNP
• Joshua Mark Bittner, PHARMD
• Ashley Bladen, ADT
• Neil David Blake, OTR/L
• Carla Blaney, CRNP
• Amie Blank, CRNP
• Mindy Sue Blank, LGPC

• Emergency Medicine Physician in Cumberland, MD
• Providers in Cumberland, MD by specialty
• Emergency Medicine Physician in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; OIG LEIE.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.