Evan H Black, MD

Primary specialty

Ophthalmic Plastic and Reconstructive Surgery PhysicianTaxonomy code 207WX0200X

License

4301071533 Issued in MI

Practice address

4717 St. Antoine
Kresge Eye Institute
Detroit, MI 48201-1423

Phone

(313) 577-8900

Fax

(313) 577-0700

NPI assigned

Dec 21, 2005

Sex

Male

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

Medicare fee-for-service enrollment

Enrolled in MI

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

Specialty

Ophthalmology

Education

University of North Carolina at Chapel Hill School of Medicine, 1994

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Consultants in Ophthalmic and Facial Plastic SurgeryGroup PAC ID 4486637006, 9 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Beaumont Hospital Royal Oak Hospital, Royal Oak, MI, CCN 230130

Procedures performed for Medicare patients

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: eblack1117669@direct.hfhs.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Consultants in Ophthalmic & Facial Plastic Surgery

  • Ophthalmology Physician
  • Southfield, MI
  • NPI 1144256777
  Medicare reassignment Care Compare group NPD
• University Physician Group

  • Internal Medicine Physician
  • Detroit, MI
  • NPI 1447299797

  Ophthalmology

  Medicare reassignment NPD
• New Millennium Surgery Center, PLLC

  • Ambulatory Surgical Clinic/Center
  • Southfield, MI
  • NPI 1366574410
  NPD (past)

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

• William Beaumont Hospital

  • General Acute Care Hospital
  • Troy, MI
  • NPI 1306825997
  Care Compare affiliation
• William Beaumont Hospital

  • General Acute Care Hospital
  • Royal Oak, MI
  • NPI 1689653305
  Care Compare affiliation
• William Beaumont Hospital

  • General Acute Care Hospital
  • Grosse Pointe, MI
  • NPI 1932396017
  Care Compare affiliation

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

{
    "created_epoch": "1135123200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1749081600000",
    "number": "1932185089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1560 E MAPLE RD",
            "address_2": "SUITE 400-CREDENTIALING",
            "city": "TROY",
            "state": "MI",
            "postal_code": "480831138",
            "telephone_number": "313-577-8900",
            "fax_number": "313-577-0700"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4717 ST. ANTOINE",
            "address_2": "KRESGE EYE INSTITUTE",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482011423",
            "telephone_number": "313-577-8900",
            "fax_number": "313-577-0700"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "29201 Telegraph Rd Ste 324",
            "address_purpose": "LOCATION",
            "city": "Southfield",
            "state": "MI",
            "postal_code": "480347646",
            "country_code": "US",
            "telephone_number": "248-357-5100",
            "fax_number": "248-746-0683",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "EVAN",
        "middle_name": "H",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-21",
        "last_updated": "2025-06-05",
        "certification_date": "2025-06-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207WX0200X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery",
            "state": "MI",
            "license": "4301071533",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3462161",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kirbi D'Amore Bivens, DC
• BJC Counseling and Behavioral Services LLC
• Black Family Development, Inc.
• Black Mothers' Breastfeeding Association
• Stacey Lynn Black-Shaw
• Judith Black
• Karen Elena Black, RN
• Kathleen Cole Black, LBSW
• Kavon Black
• Laura Frances Black, MSW, LMSW

• Ophthalmic Plastic and Reconstructive Surgery Physician in Detroit, MI
• Providers in Detroit, MI by specialty
• Ophthalmic Plastic and Reconstructive Surgery Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2025; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.