NPIMap

Individual provider Active NPI

Brandon R Black, M.D.

  • Diagnostic Radiology Physician
  • Pueblo, CO
National Provider Identifier
1740249879
Registry record updated Feb 9, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
2001015984 Issued in MO
Practice address
1619 N Greenwood St
Suite 103
Pueblo, CO 81003-2644
Phone
(719) 542-2167
Fax
(719) 542-0320
NPI assigned
Mar 18, 2006
Last updated
Feb 9, 2008By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 9, 2008

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology Physician 2085R0202X 2001015984 MO Primary

Addresses

Primary practice location

1619 N Greenwood St
Suite 103
Pueblo, CO 81003-2644

Mailing address

1619 N Greenwood St
Suite 103
Pueblo, CO 81003-2644
Phone (719) 542-2167

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CO
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
I20080801000228 CO Practitioner - Diagnostic Radiology 7416021951 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Diagnostic Radiology
Education
University of Missouri, Columbia School of Medicine, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southern Colorado Radiologists, P.C.Group PAC ID 7517959794, 11 clinicians
Parkwest Imaging, L.L.CGroup PAC ID 3173415247, 11 clinicians

Practice addresses (Care Compare)

1619 N Greenwood St
Suite 103
Pueblo, CO 81003-2655
Phone (719) 542-2167

3676 Parker Blvd
Suite 165
Pueblo, CO 81008-2212
Phone (719) 595-7600

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

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

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
2001015984MOMDDiagnostic Radiology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Southern Colorado Radiologists, P.C. CurrentSince Jul 1, 2008 Accepting new patients
Parkwest Imaging, L.L.C Diagnostic Radiology CurrentSince Jul 1, 2008 Accepting new patients
Radiology Associates Diagnostic Radiology PastSince Jul 1, 2008 Accepting new patients

Locations

1619 N Greenwood St
Ste 103
Pueblo, CO 81003
Phone (719) 542-2167

3676 Parker Blvd
Ste 165
Pueblo, CO 81008
Phone (719) 253-7040

Organizations & group practices 3

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 31

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 31

NPI Registry JSON

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

{
    "created_epoch": "1142640000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1202515200000",
    "number": "1740249879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1619 N GREENWOOD ST",
            "address_2": "SUITE 103",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032644",
            "telephone_number": "719-542-2167",
            "fax_number": "719-542-0320"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1619 N GREENWOOD ST",
            "address_2": "SUITE 103",
            "city": "PUEBLO",
            "state": "CO",
            "postal_code": "810032644",
            "telephone_number": "719-542-2167",
            "fax_number": "719-542-0320"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "BRANDON",
        "middle_name": "R",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-18",
        "last_updated": "2008-02-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "MO",
            "license": "2001015984",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pueblo, CO

Sources for this page

Verify at the official NPI Registry.