Lawrence Richard Black, DO

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

055736 Issued in FL

Practice address

13691 Metro Pkwy
350
Fort Myers, FL 33912-4327

Phone

(239) 768-5313

Fax

(239) 768-9559

NPI assigned

Aug 28, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 11

Other names 1

• Lawrence R Black Professional name

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Networks

• Freedom Health HMO Network

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Genesiscare USA of Florida LLC

  • Radiation Oncology Physician
  • Fort Myers, FL
  • NPI 1134109747

  Surgery

  Medicare reassignment NPD
• Genesiscare USA of Florida LLC

  • Urology Physician
  • Boca Raton, FL
  • NPI 1649093709
  NPD
• Genesiscare USA of Florida LLC

  • Surgical Oncology Physician
  • Fort Myers, FL
  • NPI 1659755783
  NPD
• Lawrence R. Black, D.O., P.a.

  • Specialist
  • Fort Myers, FL
  • NPI 1619178654
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156723200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1461542400000",
    "number": "1114035284",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2234 COLONIAL BLVD",
            "address_2": "ATTN: PAYER CONTRACTING & RELATIONS",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339071412",
            "telephone_number": "239-931-7342",
            "fax_number": "239-931-7385"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13691 METRO PKWY",
            "address_2": "350",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339124327",
            "telephone_number": "239-768-5313",
            "fax_number": "239-768-9559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "LAWRENCE",
        "middle_name": "RICHARD",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-08-28",
        "last_updated": "2016-04-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "FL",
            "license": "055736",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "2972830",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007256700",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "80628",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "15649",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4478694",
            "state": "FL"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "375522300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MCR",
            "identifier": "P01192863",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FREEDOM HEALTH",
            "identifier": "P304402",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AVMED",
            "identifier": "212724",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS FL",
            "identifier": "80628",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OPTIMUM",
            "identifier": "P946386",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "LAWRENCE",
            "last_name": "BLACK",
            "middle_name": "R",
            "credential": "DO",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Ian Charles Black, PA-C
• Jennifer Black, MA CCC SLP
• Katie Marie Black, MSW
• Khuri Black
• Kylee Black
• Michael Robert Black, DPM
• Stevie Blackburn-Lazalde
• Ciressa Blackwell
• Lea Moreen Blackwell, MD
• Stefanie Leigh Blackwell, M.S. CCC-SLP

• Surgery Physician in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Surgery Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.