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DR. DEREK ALAN BLACK O.D.
NPI 1114353232
Optometrist in Cumming, GA

Active since September 20, 2013PECOS EnrolledAccepts Medicare Assignment
1211 BALD RIDGE MARINA RD, CUMMING, GA 30041(470) 239-6625(470) 239-6626 Get Directions Write a Review

NPPES record last updated: October 26, 2020. Verified against the NPPES registry weekly; last sync: October 25, 2026.

Record update history: Oct 26, 2020, Apr 13, 2020 (2 updates tracked since 2020).

About Dr. Derek Alan Black O.d. NPPES

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

DR. DEREK ALAN BLACK O.D. (NPI 1114353232) is an individual optometrist in Cumming, Georgia, licensed in Georgia (OPT002922) and active in the NPI registry since September 2013. He is enrolled in Medicare PECOS, maintains a secondary practice location in Fort Belvoir, and is a graduate of Southern College Of Optometry (2013).

NPPES Registry Identity

NPI1114353232
Entity TypeIndividualMale
Primary Taxonomy152W00000X
Provider Legal NameDR. DEREK ALAN BLACKCredential: O.D.
Location Address1211 BALD RIDGE MARINA RDCumming, GA 30041-8484
Mailing Address1211 Bald Ridge Marina RdCumming, GA 30041-8484 · (470) 239-6625 · Fax (470) 239-6626
Phone(470) 239-6625
Fax(470) 239-6626
Sole ProprietorNo
Medical School CMSSouthern College Of OptometryGraduated 2013
Enumeration DateSeptember 20, 2013
Last NPPES UpdateOctober 26, 20202 updates tracked since enumeration
NPPES CertifiedOctober 26, 2020
✔ NPI 1114353232 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyOptometristEye and Vision Services Providers
Taxonomy Code152W00000X
License✔ Licensed in GA · OPT002922
Definition
Doctors of optometry (ODs) are the primary health care professionals for the eye. Optometrists examine, diagnose, treat, and manage diseases, injuries, and disorders of the visual system, the eye, and associated structures as well as identify related systemic conditions affecting the eye. An optometrist has completed pre-professional undergraduate education in a college or university and four years of professional education at a college of optometry, leading to the doctor of optometry (O.D.) degree. Some optometrists complete an optional residency in a specific area of practice. Optometrists are eye health care professionals state-licensed to diagnose and treat diseases and disorders of the eye and visual system.
1211 BALD RIDGE MARINA RD, Cumming, GA 30041
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Secondary Practice Location 1

Location 19300 DeWitt Loop, Ft Belvoir Community HospitalFort Belvoir, VA 22060-5285 · Phone (571) 231-1431

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Derek Alan Black O.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID9133410848
PECOS Enrollment IDI20160627001622
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.

Medicare Billing Reassignments

2

Medicare enrollment records show Derek Black reassigns Medicare billing to 2 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.

Lake Lanier Eye Care, LLC
6.8 mi
Optometrist
5885 CUMMING HWY STE 401-402
Sugar Hill, GA 30518
  • Reassigned Medicare billing, Georgia enrollment
  • 3 clinicians in this Medicare group
NPI 1013312453 (678) 926-3525
Eagle View Eye Care, LLC
14 mi
Optometrist
4008 MUNDY MILL RD
Oakwood, GA 30566
  • Reassigned Medicare billing, Georgia enrollment
  • 6 clinicians in this Medicare group
NPI 1508495474 (706) 576-7238

Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.

Areas of Expertise CMS Part B claims 6

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Established patient office or other outpatient visit with low level od decision making, if using time, 20 minutes or more 99213
This is a routine visit for patients who have already been seen by the healthcare provider. During this approximately 20-29 minute appointment, your health status will be evaluated and any necessary treatments or tests will be discussed. It's a chance to address any health concerns you may have.
36 services24 patients
Established patient complete exam of visual system 92014
An established patient complete exam of the visual system involves a thorough check of your eyes and vision. It assesses eye health, checks for diseases, and measures your ability to see clearly at different distances. It's a routine, non-invasive procedure.
28 services27 patients
New patient complete exam of visual system 92004
A new patient complete exam of the visual system is a thorough evaluation of your eyes and vision. It checks for any potential issues and assesses overall eye health. It includes tests for visual acuity, eye movement, and light response.
24 services24 patients
Exam of visual field with extended testing 92083
An extended visual field exam is a detailed test to evaluate your peripheral (side) vision. It helps to detect any potential blind spots which may not be noticeable in daily life. These could be caused by eye diseases like glaucoma, or neurological conditions.
17 services13 patients
Imaging of retina 92134
Imaging of the retina is a non-invasive procedure that captures detailed images of your eye's interior. This helps detect conditions like macular degeneration or retinal detachment. It's painless and takes only a few minutes.
14 services11 patients
Photography of the retina 92250
Photography of the retina, also known as retinal imaging, is a non-invasive procedure that captures images of the back of your eye. This helps doctors identify and monitor conditions like glaucoma, macular degeneration, or diabetic retinopathy. It's painless and quick, often part of a routine eye exam.
14 services12 patients

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 30041 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
$130.64 typical visit price
range $56.84 – $172.43
Typical copayment $32.66 (range $14.21 – $43.10)
Most-billed visit code 99204
Established Patient
$70.85 typical visit price
range $18.22 – $140.40
Typical copayment $17.71 (range $4.55 – $35.10)
Most-billed visit code 99213
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 5

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

COSTCO WHOLESALE CORPORATION
Pharmacy (Community/Retail Pharmacy)
1211 BALD RIDGE MARINA RD
CUMMING, GA 30041
Forsyth County (470) 239-6620
COSTCO WHOLESALE CORPORATION
Hearing Aid Equipment
1211 BALD RIDGE MARINA RD
CUMMING, GA 30041
Forsyth County (470) 239-6630
ELANA THU TRINH VO OD
Optometrist
1211 BALD RIDGE MARINA RD
CUMMING, GA 30041
Forsyth County (706) 419-9240
COSTCO WHOLESALE CORPORATION
Eyewear Supplier
1211 BALD RIDGE MARINA RD
CUMMING, GA 30041
Forsyth County (470) 239-6623
CHRISTOPHER MASLANKOWSKI
Pharmacist
1211 BALD RIDGE MARINA RD
CUMMING, GA 30041
Forsyth County (470) 239-6620

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 Derek Black's NPI number?

The NPI number for Derek Black is 1114353232. It was assigned to this individual provider in the NPPES registry on September 20, 2013.

Where is Derek Black located?

Derek Black practices at 1211 Bald Ridge Marina Rd, Cumming, GA 30041. The listed phone number is (470) 239-6625.

What is Derek Black's specialty?

The primary specialty registered for this NPI is Optometrist with taxonomy code 152W00000X.

Is Derek Black enrolled in Medicare?

Yes. Derek Black is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

Which organizations bill Medicare for Derek Black's services?

According to the CMS Revalidation Reassignment List (October 2026 release), Derek Black reassigns Medicare benefits to 2 organizations: Lake Lanier Eye Care, LLC (Sugar Hill, GA) and Eagle View Eye Care, LLC (Oakwood, GA). Each reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for Derek Black's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.

What insurance does Derek Black accept?

Health plans from Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Montana, Blue Cross and Blue Shield of Oklahoma, Blue Cross and Blue Shield of Texas and Oscar Health and 7 other insurers list Derek Black as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Derek Black was last updated on October 26, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 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.