Spencer Evan Black, MD is a medicare enrolled "Psychiatry & Neurology - Child & Adolescent Psychiatry" physician in Lehi, Utah. His current practice location is
2250 N Miller Campus Dr, Lehi, Utah. You can reach out to his office (for appointments etc.) via phone at
(859) 313-7711.
Spencer Evan Black is licensed to practice in Utah (license number 12759564-8905) and he also participates in the medicare program. He does not accept medicare assignments directly but he may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. His NPI Number is 1053842914.
Physician's Profile
Full Name | Spencer Evan Black |
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Gender | Male |
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Speciality | Psychiatry & Neurology - Child & Adolescent Psychiatry |
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Location | 2250 N Miller Campus Dr, Lehi, Utah |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1053842914
- Provider Enumeration Date: 03/22/2017
- Last Update Date: 02/20/2024
Medicare PECOS Information:
- PECOS PAC ID: 0840549267
- Enrollment ID: I20220708002696
Medical Identifiers
Medical identifiers for Spencer Evan Black such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1053842914 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
208000000X | Pediatrics | 12759564-1205 (Utah) | Secondary |
2084P0800X | Psychiatry & Neurology - Psychiatry | 12759564-1205 (Utah) | Secondary |
2084P0804X | Psychiatry & Neurology - Child & Adolescent Psychiatry | 12759564-8905 (Utah) | 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. Spencer Evan Black allows following entities to bill medicare on his behalf.
Entity Name | Ihc Health Services Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1629260880 PECOS PAC ID: 1850209420 Enrollment ID: O20031105000079 |
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Entity Name | Ihc Health Services Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
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Entity Identifiers | NPI Number: 1942325154 PECOS PAC ID: 1850209420 Enrollment ID: O20080610000303 |
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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. Spencer Evan 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 |
Spencer Evan Black, MD 295 S Chipeta Way, Salt Lake City, UT 84108-1287 Ph: (859) 313-7711 | Spencer Evan Black, MD 2250 N Miller Campus Dr, Lehi, UT 84043-7233 Ph: (859) 313-7711 |
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