Judy Black, MD in Roseburg, OR - Medicare Pediatrics

Judy Black, MD is a medicare enrolled "Pediatrics" physician in Roseburg, Oregon. Her current practice location is 1937 W Harvard Ave, Roseburg, Oregon. You can reach out to her office (for appointments etc.) via phone at (541) 677-7200.

Judy Black is licensed to practice in Oregon (license number MD 170104) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1770786667.

Contact Information

	Judy Black, MD
	1937 W Harvard Ave, Roseburg, OR 97471-2720
	(541) 677-7200
	(541) 229-3309

Map and Direction

Physician's Profile

Full Name	Judy Black
Gender	Female
Speciality	Pediatrics
Location	1937 W Harvard Ave, Roseburg, Oregon
Accepts Medicare Assignments	Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs.

NPI Data:

NPI Number: 1770786667
Provider Enumeration Date: 06/07/2007
Last Update Date: 08/07/2025

Medicare PECOS Information:

PECOS PAC ID: 7113990888
Enrollment ID: I20150306000256

Medical Identifiers

Medical identifiers for Judy Black such as npi, medicare ID, medicare PIN, medicaid, etc.

Identifier	Type	State	Issuer
1770786667	NPI	-	NPPES
500680833	Medicaid	OR
036113715	Medicaid	IL

Medical Taxonomies and Licenses

Taxonomy	Type	License (State)	Status
208000000X	Pediatrics	MD 170104 (Oregon)	Primary
202C00000X	Independent Medical Examiner	036113715 (Illinois)	Secondary
208000000X	Pediatrics	MD170104 (Oregon)	Secondary
208000000X	Pediatrics	036113715 (Illinois)	Secondary

Medicare Reassignments

Some practitioners may not bill the customers directly but medicare billing happens through clinics / group practice / hospitals where the provider works. Medicare reassignment of benefits is a mechanism by which practitioners allow third parties to bill and receive payment for medicare services performed by them. Judy Black allows following entities to bill medicare on her behalf.

Entity Name	Grants Pass Clinic Llp
Entity Type	Part B Supplier - Clinic/group Practice
Entity Identifiers	NPI Number: 1760418032 PECOS PAC ID: 9234123977 Enrollment ID: O20040414000467

Medicare Part D Prescriber Enrollment

Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Judy Black is enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.

Mailing Address and Practice Location

Mailing Address	Practice Location Address
Judy Black, MD 2570 Nw Edenbower Blvd Ste 100, Roseburg, OR 97471-6214 Ph: (541) 677-7200	Judy Black, MD 1937 W Harvard Ave, Roseburg, OR 97471-2720 Ph: (541) 677-7200

Reviews and Comments

Pediatrics Doctors in Roseburg, OR

Ebelosele El-hannan Aigbivbalu, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 2700 Nw Stewart Parkway, Roseburg, OR 97471 Phone: 541-677-2888
Andrew Groshong, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 272 Nw Medical Loop Ste B, Roseburg, OR 97471 Phone: 541-957-5437
Adam Kanafani, Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 2700 Nw Stewart Pkwy, Roseburg, OR 97471 Phone: 541-677-4319 Fax: 541-677-2294
Elise Anne Lippincott, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 2570 Nw Edenbower Blvd, Roseburg, OR 97471 Phone: 541-677-7200
Robert Louis Dannenhoffer, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 150 Ne Kenneth Ford Dr, Roseburg, OR 97470 Phone: 541-672-9596
Dr. Lucinda Jane Dykes, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 913 Nw Garden Valley Blvd, Roseburg, OR 97471 Phone: 800-549-8387 Fax: 541-440-1334
Dr. Elizabeth Bish Young, M.D. Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 901 Bellwood Ln, Roseburg, OR 97471 Phone: 541-580-0345

Judy Black, MD - Medicare Pediatrics in Roseburg, OR