NPIMap

Individual provider Active NPI

Curtis Legrand Black, M.D.

  • Family Medicine Physician
  • Philomath, OR
National Provider Identifier
1962522367
Registry record updated Jun 25, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
166825 Issued in OR
Practice address
1219 Applegate St
Philomath, OR 97370-2031
Phone
(541) 929-2922
NPI assigned
Mar 30, 2007
Last updated
Jun 25, 2014By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 25, 2014

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 59668451205 UT
Family Medicine Physician 207Q00000X 166825 OR Primary

Addresses

Primary practice location

1219 Applegate St
Philomath, OR 97370-2031

Mailing address

1219 Applegate St
PO Box 460
Philomath, OR 97370-2031
Phone (541) 929-2922

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20140908001223 OR Practitioner - Family Practice 0446276117 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Medical College of Wisconsin, 2004
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
The Corvallis Clinic P CGroup PAC ID 1456244540, 128 clinicians

Practice addresses (Care Compare)

444 NW Elks Dr
Corvallis, OR 97330-3745
Phone (541) 754-1150

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions1-10
Removal or shaving of skin growth1-10
Skin biopsy1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
166825ORMDFamily Medicine Physician
59668451205UTMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Corvallis Clinic P C CurrentSince Jul 28, 2014 Accepting new patients
Philomath Family Medicine, P.C. Past Accepting new patients

Locations

3680 NW Samaritan Dr
Corvallis, OR 97330
Phone (541) 754-1282

444 NW Elks Dr
Corvallis, OR 97330
Phone (541) 754-1256

500 Main St
Philomath, OR 97370
Phone (541) 609-4071

Interoperability endpoints

  • Direct secure messaging: curtis.black.1@14349.direct.athenahealth.com
  • FHIR API: https://api.platform.athenahealth.com/14349/brand/4/csg/42/fhir/r4

Organizations & group practices 2

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 53

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

View all 53

NPI Registry JSON

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1403654400000",
    "number": "1962522367",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1219 APPLEGATE ST",
            "address_2": "PO BOX 460",
            "city": "PHILOMATH",
            "state": "OR",
            "postal_code": "973702031",
            "telephone_number": "541-929-2922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1219 APPLEGATE ST",
            "city": "PHILOMATH",
            "state": "OR",
            "postal_code": "973702031",
            "telephone_number": "541-929-2922"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "CURTIS",
        "middle_name": "LEGRAND",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-30",
        "last_updated": "2014-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "UT",
            "license": "59668451205",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OR",
            "license": "166825",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philomath, OR

Sources for this page

Verify at the official NPI Registry.