Eva Marie Black, FNP-BC is a medicare enrolled "Nurse Practitioner - Family" in Carrollton, Alabama. Her current practice location is
376 Commerce Ave, Carrollton, Alabama. You can reach out to her office (for appointments etc.) via phone at
(205) 614-6228.
Eva Marie Black is licensed to practice in Alabama (license number 1-168015) 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 1134765886.
Provider's Profile
| Full Name | Eva Marie Black |
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| Gender | Female |
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| Speciality | Nurse Practitioner - Family |
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| Location | 376 Commerce Ave, Carrollton, Alabama |
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| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
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NPI Data:
- NPI Number: 1134765886
- Provider Enumeration Date: 11/18/2019
- Last Update Date: 07/31/2025
Medicare PECOS Information:
- PECOS PAC ID: 8325419013
- Enrollment ID: I20230117000169
Medical Identifiers
Medical identifiers for Eva Marie Black such as npi, medicare ID, medicare PIN, medicaid, etc.
| Identifier | Type | State | Issuer |
|---|
| 1134765886 | NPI | - | NPPES |
| 1-168015 | Other | AL | ALABAMA LICENSE |
| 901756 | Other | MS | MISSISSIPPI LICENSE |
Medical Taxonomies and Licenses
| Taxonomy | Type | License (State) | Status |
|---|
| 363LF0000X | Nurse Practitioner - Family | 901756 (Mississippi) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | 1-168015 (Alabama) | Primary |
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. Eva Marie Black allows following entities to bill medicare on her behalf.
| Entity Name | Grundy County Health Services Inc |
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| Entity Type | Part B Supplier - Clinic/group Practice |
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| Entity Identifiers | NPI Number: 1770588683
PECOS PAC ID: 6800844200
Enrollment ID: O20240214004077 |
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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. Eva Marie 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 |
|---|
Eva Marie Black, FNP-BC
91 Phoenix Ave,
Carrollton, AL 35447-2351
Ph: (662) 549-4050 | Eva Marie Black, FNP-BC
376 Commerce Ave,
Carrollton, AL 35447-2253
Ph: (205) 614-6228 |
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