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JERROLD G BLACK MD
NPI 1104833904
Family Medicine in Woodbridge, VA

Active since August 02, 2006PECOS Enrolled
4167 MERCHANT PLZ, WOODBRIDGE, VA 22192(703) 878-8800(703) 878-2133 Get Directions Write a Review

NPPES record last updated: February 28, 2011. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Jerrold G Black Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JERROLD G BLACK MD (NPI 1104833904) is an individual family medicine provider in Woodbridge, Virginia, licensed in Indiana (01063821A) and active in the NPI registry since August 2006. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1104833904
Entity TypeIndividualMale
Primary Taxonomy207Q00000X
Provider Legal NameJERROLD G BLACKCredential: MD
Location Address4167 MERCHANT PLZWoodbridge, VA 22192-5088
Mailing Address4167 Merchant PlzWoodbridge, VA 22192-5088 · (703) 878-8800 · Fax (703) 878-2133
Phone(703) 878-8800
Fax(703) 878-2133
Sole ProprietorNo
Enumeration DateAugust 2, 2006
Last NPPES UpdateFebruary 28, 2011
✔ NPI 1104833904 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyFamily MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207Q00000X
License✔ Licensed in IN · 01063821A
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
4167 MERCHANT PLZ, Woodbridge, VA 22192
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Other Identifiers 3

Medicaid1104833904VA
Medicare UPIND16938
Medicare PIN146470D3IN

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Jerrold G Black Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 22192 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$86.88 typical visit price
range $56.19 – $170.30
Typical copayment $21.72 (range $14.04 – $42.57)
Most-billed visit code 99203
Established Patient
$99.13 typical visit price
range $18.07 – $138.91
Typical copayment $24.78 (range $4.51 – $34.72)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 2

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. GRAHAM TODD DONDLINGER M.D.
Internal Medicine
4167 MERCHANT PLZ
WOODBRIDGE, VA 22192
Prince William County (703) 878-8800
ALLCARE VA INC
Clinic/Center (Urgent Care)
4167 MERCHANT PLZ
WOODBRIDGE, VA 22192
Prince William County (703) 878-8800

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Jerrold Black's NPI number?

The NPI number for Jerrold Black is 1104833904. It was assigned to this individual provider in the NPPES registry on August 2, 2006.

Where is Jerrold Black located?

Jerrold Black practices at 4167 Merchant Plz, Woodbridge, VA 22192. The listed phone number is (703) 878-8800.

What is Jerrold Black's specialty?

The primary specialty registered for this NPI is Family Medicine with taxonomy code 207Q00000X.

Is Jerrold Black enrolled in Medicare?

Yes. Jerrold Black is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Jerrold Black was last updated on February 28, 2011. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 15 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.