NPIMap

Individual provider Active NPI

Richard Black, MD

  • Internal Medicine Physician
  • Braintree, MA
National Provider Identifier
1669473955
Registry record updated Nov 27, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
71590 Issued in MA
Practice address
340 Wood Road
Braintree, MA 02184
Phone
(781) 878-5200
Fax
(781) 878-6750
NPI assigned
Aug 9, 2005
Last updated
Nov 27, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 27, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X 71590 MA Primary

Addresses

Primary practice location

340 Wood Road
Braintree, MA 02184

Mailing address

141 Longwater Drive
Suite 201
Norwell, MA 02061
Phone (781) 792-4136

Other identifiers 2

IdentifierTypeStateIssuer
110051363AMedicaidMA
3093158MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20060407000473 MA Practitioner - Internal Medicine 5991714636 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
Boston University School of Medicine, 1987
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
South Shore Medical Center, Inc.Group PAC ID 3678487444, 174 clinicians

Practice addresses (Care Compare)

1495 Hancock St
Quincy, MA 02169-5229
Phone (781) 878-5200

Hospital & facility affiliations

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
South Shore Medical Center, Inc. Internal Medicine CurrentSince Aug 1, 2018 Accepting new patients

Locations

340 Wood Rd
Braintree, MA 02184
Phone (781) 356-0668

5 Tarkiln Rd
Kingston, MA 02364
Phone (781) 585-2200

141 Longwater Dr
Ste 201
Norwell, MA 02061
Phone (781) 261-7820

1495 Hancock St
Quincy, MA 02169
Phone (617) 745-4100

55 Fogg Rd
Weymouth, MA 02190
Phone (781) 340-4293

90 Libbey Park
Weymouth, MA 02189
Phone (781) 331-0537

Organizations & group practices 1

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": "1123545600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1543276800000",
    "number": "1669473955",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "141 LONGWATER DRIVE",
            "address_2": "SUITE 201",
            "city": "NORWELL",
            "state": "MA",
            "postal_code": "02061",
            "telephone_number": "781-792-4136",
            "fax_number": "781-878-6750"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "340 WOOD ROAD",
            "city": "BRAINTREE",
            "state": "MA",
            "postal_code": "02184",
            "telephone_number": "781-878-5200",
            "fax_number": "781-878-6750"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "RICHARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-09",
        "last_updated": "2018-11-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "MA",
            "license": "71590",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110051363A",
            "state": "MA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3093158",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Braintree, MA

Sources for this page

Verify at the official NPI Registry.