Eric Black, PA-C
Individual provider Active NPI Medical Physician Assistant · Hamden, CT
NPI 1962874792 · NPPES record last updated Oct 20, 2015
Key facts
- NPI
- 1962874792
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Physician Assistant 363AM0700X
- License
- 3462 (CT)
- Practice address
- 1650 Dixwell Ave
Hamden, CT 06514-3615 - Phone
- (203) 288-1700
- NPI assigned
- Oct 20, 2015
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Hospital & facility affiliations 2
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2015
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Emergency Physicians of Connecticut PC
Practice addresses (Care Compare)
130 Division St
Derby, CT 06418-1326
Phone (203) 735-7421
64 Robbins St
Waterbury, CT 06708-2613
Phone (203) 573-7306
Hospital & facility affiliations
- Griffin Hospital
- St Vincent'S Medical Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 90.42 of 100
- Quality
- 83.36
- Promoting interoperability
- 100
- Improvement activities
- 40
- Cost
- 75.9
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in CT
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20170629002446 | CT | Practitioner - Physician Assistant | 5597034801 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Hartford Healthcare Medical Group Specialists LLC | Current |
Accepting new patients | |
| Hartford Healthcare Medical Group Specialists, PLLC | Current |
Accepting new patients |
Locations
130 Division St
Derby, CT 06418
Phone (203) 732-1330
1244 Storrs Rd
Storrs Mansfield, CT 06268
Phone (860) 724-2579
64 Robbins St
Waterbury, CT 06708
Phone (203) 573-7142
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Physician Assistant | 363AM0700X | 3462 | CT | Yes |
Addresses
Primary practice location
1650 Dixwell Ave
Hamden, CT 06514-3615
Mailing address
204 8TH Ave
Haddon Heights, NJ 08035-1631
Phone (609) 605-0333
Other providers in Hamden, CT
- Renate Birmingham
- Ronald Brian Birmingham
- Erica E Bishop
- Sarah Bishop
- Jacquelyn G Blaber
- Nakia S Black
- Betty Blackwell
- Jeffrey Blain
- Adriana Blanco
- Steven J Blander
All providers in Hamden, CT · Medical Physician Assistant in Connecticut
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 20, 2015. 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.