DR. MARY LEWIS BLACK MD
NPI 1780716084
Pediatrics in Fort Gordon, GA
About Dr. Mary Lewis Black Md NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
DR. MARY LEWIS BLACK MD (NPI 1780716084) is an individual pediatrics provider in Fort Gordon, Georgia, licensed in Georgia (059094) and active in the NPI registry since March 2007. She is enrolled in Medicare PECOS.
NPPES Registry Identity
Specialties & Licenses
Accepted Insurance
Medicare Participation & PECOS CMS
Medicare enrollment, assignment, billing reassignment, and ordering and referring status from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Dr. Mary Lewis Black Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Medicare Billing Reassignments
3Medicare enrollment records show Mary Black reassigns Medicare billing to 3 organizations. Each organization bills Medicare for the services this provider delivers there; the nearest is listed first.
Macon, GA 31201
- Reassigned Medicare billing, Georgia enrollment
- 108 clinicians in this Medicare group
Roswell, GA 30076
- Reassigned Medicare billing, Georgia enrollment
- 3,885 clinicians in this Medicare group
Myrtle Beach, SC 29572
- Reassigned Medicare billing, Georgia enrollment
- 586 clinicians in this Medicare group
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Physician Visit Costs CMS claims · ZIP area
Typical Medicare office-visit costs in the 30905 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.
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.
FORT GORDON, GA 30905
FORT GORDON, GA 30905
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 Mary Black's NPI number?
The NPI number for Mary Black is 1780716084. It was assigned to this individual provider in the NPPES registry on March 12, 2007.
Where is Mary Black located?
Mary Black practices at 300 W Hospital Rd, Fort Gordon, GA 30905. The listed phone number is (706) 787-7300.
What is Mary Black's specialty?
The primary specialty registered for this NPI is Pediatrics with taxonomy code 208000000X.
Is Mary Black enrolled in Medicare?
Yes. Mary Black is registered in the Medicare PECOS enrollment system.
Which organizations bill Medicare for Mary Black's services?
According to the CMS Revalidation Reassignment List (October 2026 release), Mary Black reassigns Medicare benefits to 3 organizations: Central Georgia Emergency Group, LLC (Macon, GA), Wellstar Medical Group, LLC (Roswell, GA) and Acs Primary Care Physicians - Southeast PC (Myrtle Beach, SC). 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 Mary Black's services. Reassignment records can lag staffing changes; confirm current arrangements with the organization.
What insurance does Mary Black accept?
Health plans from Alliant Health Plans, Inc. list Mary 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 Mary Black was last updated on November 17, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 11 months 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.
# Dr. Mary Lewis Black, MD · NPI 1780716084
Pediatrics physician in Fort Gordon, Georgia. Individual provider, active in the CMS NPPES registry since March 12, 2007.
## Identity
- **NPI:** 1780716084 (Entity type: Individual)
- **Enumerated:** March 12, 2007
- **Primary specialty:** Pediatrics · taxonomy 208000000X
- **State license:** 059094 (Georgia)
- **Sole proprietor:** No
## Practice location
- **Address:** 300 W HOSPITAL RD, Fort Gordon, GA 30905-5741
- **Phone:** (706) 787-7300
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Ordering & referring:** eligible for Part B labs & imaging, durable medical equipment, home health, power mobility devices
- **Bills Medicare through:** 3 organizations under Medicare reassignment (form CMS-855R): Central Georgia Emergency Group, LLC (NPI 1598126641, Macon, GA); Wellstar Medical Group, LLC (NPI 1922405729, Roswell, GA); Acs Primary Care Physicians - Southeast PC (NPI 1861430555, Myrtle Beach, SC) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** November 17, 2025
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Source: [NPI Profile](https://npiprofile.com/npi/1780716084) · Data from the CMS NPPES public registry.