Colleen Rochelle Black, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

2008-00927 Issued in NC

Practice address

6555 Kee LN Ste 200
Harrisburg, NC 28075-7463

Phone

(704) 316-6140

Fax

(704) 316-6141

NPI assigned

May 2, 2008

Last updated

Oct 26, 2020By the provider in NPPES

Sex

Female

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

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

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cblack566317@direct.novanthealth.org

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.

• Novant Health Medical Group, LLC

  dba Novant Health Pediatric Neurology & Sleep

  • Neurology with Special Qualifications in Child Neurology Physician
  • Charlotte, NC
  • NPI 1366409492
  Medicare reassignment NPD
• Novant Health Medical Group, LLC

  dba Novant Health Elizabeth OB/GYN

  • Obstetrics & Gynecology Physician
  • Matthews, NC
  • NPI 1386506137
  NPD
• Novant Medical Group, Inc.

  dba Novant Health Pediatrics Plaza Midwood

  • Pediatrics Physician
  • Charlotte, NC
  • NPI 1073026019
  NPD
• Novant Health Medical Group, LLC

  dba Novant Health Northlake Dermatology

  • Dermatopathology Physician
  • Huntersville, NC
  • NPI 1396751640
  NPD (past)

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

{
    "created_epoch": "1209686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1603670400000",
    "number": "1508032194",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447",
            "telephone_number": "844-266-8268"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6555 KEE LN STE 200",
            "city": "HARRISBURG",
            "state": "NC",
            "postal_code": "280757463",
            "telephone_number": "704-316-6140",
            "fax_number": "704-316-6141"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1918 Randolph Rd Ste 700",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "28207",
            "country_code": "US",
            "telephone_number": "704-384-1056",
            "fax_number": "704-384-1046",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "9550 Rocky River Rd Ste 150",
            "address_purpose": "LOCATION",
            "city": "Charlotte",
            "state": "NC",
            "postal_code": "282159592",
            "country_code": "US",
            "telephone_number": "704-316-6140",
            "fax_number": "704-316-6141",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "COLLEEN",
        "middle_name": "ROCHELLE",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-05-02",
        "last_updated": "2020-10-26",
        "certification_date": "2020-09-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NC",
            "license": "2008-00927",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5916285",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "cblack566317@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "1918 Randolph Rd Ste 700",
            "city": "Charlotte",
            "state": "NC",
            "country_code": "US",
            "postal_code": "28207",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Norman Lane Beam, DDS PA
• Haley Noel Bearden, DPT
• Daniela Lisel Beauvais, PT
• John Timothy Bellis Jr., LCSW
• Benchmark Physical Therapy of NC, LLC
• Tanika Blackmon, LPN
• Esther Lavenia Blanks-Sheard, MD
• Blue Rabbit Logistics & Solutions LLC
• Tyeekia Blue, MSW, LCSWA
• Crystal Michelle Boggs, FNP

• Pediatrics Physician in Harrisburg, NC
• Providers in Harrisburg, NC by specialty
• Pediatrics Physician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 26, 2020; 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.