NPIMap

Individual provider Active NPI

Justin Clint Black, MD

  • Diagnostic Radiology Physician
  • Hickory, NC
National Provider Identifier
1508206285
Registry record updated May 13, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
2018-01112 Issued in NC
Practice address
18 13TH Ave NE
Hickory, NC 28601-3748
Phone
(828) 322-2644
Fax
(828) 327-2235
NPI assigned
Jun 26, 2013
Last updated
May 13, 2021By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 13, 2021

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Physician 208D00000X LL35690 SC
Diagnostic Radiology Physician 2085R0202X 2018-01112 NC Primary

Addresses

Primary practice location

18 13TH Ave NE
Hickory, NC 28601-3748

Mailing address

PO Box 308
Hickory, NC 28603-0308
Phone (828) 322-2644

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
I20200406001254 NC Practitioner - Diagnostic Radiology 8820222458 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Catawba Radiological Associates IncGroup PAC ID 9335036789, 17 clinicians
Caldwell Memorial Hospital IncGroup PAC ID 5395646970, 212 clinicians

Practice addresses (Care Compare)

18 Thirteenth Ave NE
Hickory, NC 28601-3748
Phone (828) 322-2644

321 Mulberry St SW
Lenoir, NC 28645-5720
Phone (828) 394-6722

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
100 of 100Reported as group
Quality
100
Improvement activities
40

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
2018-01112NCMDDiagnostic Radiology Physician
LL35690SCMDGeneral Practice Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Caldwell Memorial Hospital Inc. Diagnostic Radiology CurrentSince Aug 18, 2025 Accepting new patients
Caldwell Memorial Hospital, Inc Current Accepting new patients
Catawba Radiological Associates, Inc. Diagnostic Radiology CurrentSince Jan 8, 2020 Accepting new patients
Catawba Valley Medical Center Diagnostic Radiology CurrentSince Aug 31, 2024 Accepting new patients
Caldwell Memorial Hospital, Inc. CurrentSince Aug 18, 2025 Accepting new patients
Caldwell Memorial Hospital, Inc Past Accepting new patients

Locations

18 13th Ave NE
Hickory, NC 28601
Phone (828) 322-2644

212 Mulberry St SW
Lenoir, NC 28645
Phone (828) 757-5100

321 Mulberry St SW
Lenoir, NC 28645
Phone (828) 757-5100

Organizations & group practices 6

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": "1372204800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620864000000",
    "number": "1508206285",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 308",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286030308",
            "telephone_number": "828-322-2644",
            "fax_number": "828-327-2235"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "18 13TH AVE NE",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286013748",
            "telephone_number": "828-322-2644",
            "fax_number": "828-327-2235"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "JUSTIN",
        "middle_name": "CLINT",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-06-26",
        "last_updated": "2021-05-13",
        "certification_date": "2021-05-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208D00000X",
            "taxonomy_group": "",
            "desc": "General Practice",
            "state": "SC",
            "license": "LL35690",
            "primary": false
        },
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "NC",
            "license": "2018-01112",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hickory, NC

Sources for this page

Verify at the official NPI Registry.