Bruce T Black, M.D.
Individual provider Active NPI Family Medicine Physician · Madison, MS
NPI 1730199290 · NPPES record last updated Feb 12, 2018
Key facts
- NPI
- 1730199290
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 18358 (MS)
- Practice address
- 401 Baptist Dr
Suite 104
Madison, MS 39110-2009 - Phone
- (601) 605-3858
- Fax
- (601) 605-3898
- NPI assigned
- Aug 8, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 4
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- University of Mississippi School of Medicine, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
- Group practices
- Medical Foundation of Central Mississippi Inc
Practice addresses (Care Compare)
110 S Pearson Rd
Pearl, MS 39208-5635
Phone (601) 968-1237
1225 N State St
Jackson, MS 39202-2064
Phone (601) 292-4261
1887 Spillway Rd
Brandon, MS 39047-6066
Phone (601) 992-2553
2173 Main St
Madison, MS 39110-6309
Phone (601) 605-3858
401 Baptist Dr
Suite 104
Madison, MS 39110-2010
Phone (601) 973-1504
Hospital & facility affiliations
- Mississippi Homecare of Jackson
- Mississippi Baptist Medical Center
- Mississippi Methodist Rehab Ctr
Merit-based Incentive Payment System (MIPS)
- Final score
- 78.38 of 100
- Quality
- 54.22
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 73.72
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
| Removal of nail tissue | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MS
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050607000393 | MS | Practitioner - Family Practice | 8729021118 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 18358 | MS | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Medical Foundation of Central Ms | Family Medicine | Current |
Accepting new patients |
| Medical Foundation of Central Mississippi, Inc. | Family Medicine | Current |
Accepting new patients |
| River Oaks Management Company LLC | Family Medicine | Past | Accepting new patients |
Locations
1225 N State St
Jackson, MS 39202
Phone (601) 292-4261
2173 Main St
Madison, MS 39110
Phone (601) 605-3858
401 Baptist Dr
Ste 104
Madison, MS 39110
Phone (601) 605-2383
965 Ridge Lake Blvd
Ste 103
Memphis, TN 38120
Phone (901) 227-3221
Interoperability endpoints
- bblack148902@direct.bmhcc.org
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 18358 | MS | Yes |
Addresses
Primary practice location
401 Baptist Dr
Suite 104
Madison, MS 39110-2009
Mailing address
965 Ridge Lake Blvd Ste 103
Memphis, TN 38120-9446
Phone (901) 227-3255
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07401794 | Medicaid | MS |
Other providers in Madison, MS
- Anne Caroline Berry
- Katie Berry
- Bespoke Aesthetics and Plastic Surgery
- Arianna Leigh Bierdeman
- Takinya Raneese Binion Minor
- Jessi Jones Blissett
- Bluehealth Baptist, LLC
- Mallory Elizabeth Boggs
- Charmaine Bolden
- Kyskie Bolton
All providers in Madison, MS · Family Medicine Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 12, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.