SAMUEL JACOB BLACK MD, PHD
NPI 1124697958
Student in an Organized Health Care Education/Training Program in Philadelphia, PA

Active since June 24, 2021PECOS EnrolledAccepts Medicare Assignment
3322 N BROAD ST, PHILADELPHIA, PA 19140(215) 707-1800 Get Directions Write a Review

NPPES record last updated: June 26, 2021. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Samuel Jacob Black Md, Phd NPPES

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

SAMUEL JACOB BLACK MD, PHD (NPI 1124697958) is an individual student in an organized health care education/training program in Philadelphia, Pennsylvania, licensed in Pennsylvania (MT222514) and active in the NPI registry since June 2021. He is enrolled in Medicare PECOS, is affiliated with Temple University Hospital, and is a graduate of Temple University School Of Medicine (2021).

NPPES Registry Identity

NPI1124697958
Entity TypeIndividualMale
Primary Taxonomy390200000X
Provider Legal NameSAMUEL JACOB BLACKCredential: MD, PHD
Location Address3322 N BROAD STPhiladelphia, PA 19140-5185
Mailing Address3401 N Broad St Ste 810Philadelphia, PA 19140-5189 · (215) 707-4085 · Fax (215) 707-5978
Sole ProprietorNo
Medical School CMSTemple University School Of MedicineGraduated 2021
Enumeration DateJune 24, 2021
Last NPPES UpdateJune 26, 2021
NPPES CertifiedJune 26, 2021
NPI 1124697958 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Taxonomy Code390200000X
License Licensed in PA · MT222514
Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

Also ListedInternal MedicineTaxonomy 207R00000X · License MT222514 (PA)
3322 N BROAD ST, Philadelphia, PA 19140

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

Enrolled in Medicare and accepts Medicare assignment

Samuel Jacob Black Md, Phd 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 ID2769883495
PECOS Enrollment IDI20240404000210
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.

Areas of Expertise CMS Part B claims

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.

Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes 99232
Follow-up hospital inpatient care involves daily check-ups while you're admitted in the hospital. Typically, a healthcare provider spends about 25 minutes each day reviewing your condition, adjusting treatment if needed, and answering any questions you might have.
61 services17 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

Temple University Hospital

Acute Care Hospitals · Philadelphia, PA
3/5 CMS rating
OwnershipVoluntary non-profit - Private
CMS Certification Number390027
Location3401 North Broad StreetPhiladelphia, PA 19140 · Philadelphia County
Emergency services Birthing friendly

Other Providers at the Same Location NPPES 20

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

Internal Medicine
3322 N BROAD ST
PHILADELPHIA, PA 19140
Internal Medicine
3322 N BROAD ST
PHILADELPHIA, PA 19140
Internal Medicine
3322 N BROAD ST
PHILADELPHIA, PA 19140
Internal Medicine
3322 N BROAD ST
PHILADELPHIA, PA 19140
Internal Medicine
3322 N BROAD ST
PHILADELPHIA, PA 19140
Pediatrics
3322 N BROAD ST
PHILADELPHIA, PA 19140
Internal Medicine
3322 N BROAD ST
PHILADELPHIA, PA 19140
Family Medicine
3322 N BROAD ST, 2ND FL CANCER CENTER
PHILADELPHIA, PA 19140

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 Samuel Black's NPI number?

The NPI number for Samuel Black is 1124697958. It was assigned to this individual provider in the NPPES registry on June 24, 2021.

Where is Samuel Black located?

Samuel Black practices at 3322 N Broad St, Philadelphia, PA 19140. The listed phone number is (215) 707-1800.

What is Samuel Black's specialty?

The primary specialty registered for this NPI is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Is Samuel Black enrolled in Medicare?

Yes. Samuel 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.

Is Samuel Black affiliated with any hospitals?

According to CMS data, Samuel Black is affiliated with Temple University Hospital.

When was this NPI record last updated?

The NPPES record for Samuel Black was last updated on June 26, 2021. NPI Profile syncs with the weekly NPPES data releases published by CMS.