Evan G Black


Address: 1434 E 4500, Suite 100, Salt Lake City, UT 84117-4252

Evan G Black (NPI# 1346260247, PAC ID# 6103724554) is a physician enrolled in Centers for Medicare & Medicaid Services (CMS). The primary specialty is NEUROLOGY.

Physician Overview

Nation Provider ID (NPI) 1346260247
PAC ID by PECOS 6103724554
Professional Enrollment ID I20031223000339
Full Name Evan G Black
Address 1434 E 4500
Suite 100
Salt Lake City
UT 84117-4252
Gender M
Credential MD
Medical School UNIVERSITY OF UTAH SCHOOL OF MEDICINE
Graduation Year 1991
Primary Specialty NEUROLOGY
Accepts Medicare Assignment Y

Claims Based Hospital Affiliation

Claim Control Number (CCN) Legal Business Name
460047 ST MARK'S HOSPITAL
460042 LAKEVIEW HOSPITAL
460060 LONE PEAK HOSPITAL

Other Locations

Address Phone Organization
1200 E 3900, Salt Lake City, UT 84124-1300 8012687134 ST MARKS PROFESSIONAL SERVICES LLC
1434 E 4500, Suite 100, Salt Lake City, UT 84117-4252

Individual EP (Eligible Professionals) Public Reporting – Performance Scores
Physician Quality Reporting System (PQRS) and non-PQRS Qualified Clinical Data Registry (QCDR)

Measure Identifier Measure Title Performance Rate Reporting Mechanism
ACI_EC_TRANS_EP_1 e-Prescribing 71%
ACI_EC_TRANS_PEA_1 Provide Patient Access 100%

Organization Information

Office Location

Street Address 1434 E 4500
SUITE 100
City SALT LAKE CITY
State UT
Zip 84117-4252

Physicians in the same location

Name Specialty Organization Address
Diana D Banks Neurology 1434 E 4500, Suite 100, Salt Lake City, UT 84117-4252
Erika C Lloyd General Surgery 1434 E 4500, Suite 200, Salt Lake City, UT 84117-4255

Physicians in the same zip code

Name Specialty Organization Address
David A Mehregan Pathology Utah Pathology Service Inc 5330 S 900 E, Suite 120, Salt Lake City, UT 84117-3504
Julie A Jackson Pathology Utah Pathology Service Inc 5330 S 900 E, Suite 120, Salt Lake City, UT 84117-3504
Isaac E Lloyd Pathology Utah Pathology Service Inc 5330 S 900 E, Suite 120, Salt Lake City, UT 84117-3504
Ralph W Gant Clinical Psychologist 5525 S 900 E Plaza II, Suite 102, Murray, UT 84117-3505
Scott Asay Chiropractic Apollo Health Centers 5525 S 900, Suite 310, Murray, UT 84117-3516
Timothy P Young Family Medicine Apollo Health Centers 5525 S 900, Suite 310, Murray, UT 84117-3516
Travis Castillon Chiropractic Apollo Health Centers 5525 S 900, Suite 310, Murray, UT 84117-3516
Jason Dayne Petersen Plastic and Reconstructive Surgery J Dayne Petersen Md PC 5353 S 960, Salt Lake City, UT 84117-3533
Summer Rae Kottsick Nurse Practitioner Ihc Health Services Inc 2160 E 4500, Holladay Pedia N, Salt Lake City, UT 84117-4011
Andrea Loving Nurse Practitioner 2180 E 4500, Suite 105, Holladay, UT 84117-4017
Find all physicians in zip 84117

Competitor

Search similar physicians

City SALT LAKE CITY
Zip Code 84117
Specialty NEUROLOGY
City + Specialty SALT LAKE CITY + NEUROLOGY

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS)
Jurisdiction Medicare

This dataset includes 1.12 million groups, individual physicians, and other clinicians currently enrolled in Medicare. Each physician is registered with NPI, PAC ID, full name, specialty, phone, organization, hospital, address, medical school, etc.

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