Charles Black, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

L011576 Issued in LA

Practice address

1534 Elizabeth Ave
Suite 202
Shreveport, LA 71101-4516

Phone

(318) 681-7350

Fax

(318) 681-7351

NPI assigned

Jun 5, 2006

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

Other identifiers 1

Other names 1

• Dr. Charles Black Professional name

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

State licenses

Practice roles

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.

• Charles L. Black Jr MD Surgical Clinic Corp

  • Surgery Physician
  • Shreveport, LA
  • NPI 1952442832
  NPD (past) Authorized official

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

{
    "created_epoch": "1149465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1189728000000",
    "number": "1992744981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1534 ELIZABETH AVE",
            "address_2": "SUITE 202",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014516",
            "telephone_number": "318-681-7350",
            "fax_number": "318-681-7351"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1534 ELIZABETH AVE",
            "address_2": "SUITE 202",
            "city": "SHREVEPORT",
            "state": "LA",
            "postal_code": "711014516",
            "telephone_number": "318-681-7350",
            "fax_number": "318-681-7351"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "CHARLES",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-05",
        "last_updated": "2007-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "LA",
            "license": "L011576",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1169838",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHARLES",
            "last_name": "BLACK",
            "prefix": "DR.",
            "credential": "M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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

• Surgery Physician in Shreveport, LA
• Providers in Shreveport, LA by specialty
• Surgery Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 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.