Charles Leonard Black, M.D.

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

015534 Issued in LA

Practice address

7600 General Motors Blvd
Medical Department
Shreveport, LA 71129-9426

Phone

(318) 683-9503

Fax

(318) 683-9697

NPI assigned

Jan 19, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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

{
    "created_epoch": "1169164800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962555342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6006 E RIDGE DR",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711062426",
            "telephone_number": "318-861-7555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7600 GENERAL MOTORS BLVD",
            "address_2": "MEDICAL DEPARTMENT",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711299426",
            "telephone_number": "318-683-9503",
            "fax_number": "318-683-9697"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "CHARLES",
        "middle_name": "LEONARD",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "LA",
            "license": "015534",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Billie Elizabeth Bitowski, RNC FNP
• Melodee Bivens, PHARMD
• Breanna Black, CRNA
• Catherine Jean Black
• Charles Black, M.D.
• Destin R. Black, MD
• John James Black
• Johnny Lynn Black, D.D.S.
• Lavette Black
• Tara J Black

• Emergency Medicine Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Emergency Medicine Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.