Active NPI
Gregory Scott Black, O.D.
- Optometrist
- Davie, FL
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OPC2975
- Practice address
- 3200 S University Dr
Nsu College of Optometry Suite 1402
Davie, FL 33328-2018 - Phone
- (954) 262-1402
- Fax
- (954) 262-1818
- NPI assigned
- Oct 27, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OPC2975 | FL | Primary |
Addresses
Primary practice location
3200 S University Dr
Nsu College of Optometry Suite 1402
Davie, FL 33328-2018
Mailing address
881 Camellia CT
Plantation, FL 33317-1350
Phone (954) 581-7291
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 620573900 | Medicaid | FL |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in FL, TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 2
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- Indiana University - School of Optometry, 1996
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
436 5TH St
Kotzebue, AZ 99752-0043
PO Box
Suite 43
Kotzebue, AK 99752-0043
Hospital & facility affiliations
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OPC2975 | FL | MD | Optometrist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Maniilaq Association | Current | Accepting new patients | |
| Maniilaq Association | Current | Accepting new patients | |
| Nova Southeastern University, Inc | Optometrist | Current | Accepting new patients |
| Nova Southeastern University, Inc | Current | Accepting new patients | |
| Nova Southeastern University Inc. | Current | Accepting new patients |
Locations
3200 S University Dr
Ste 1402
Davie, FL 33328
Phone (954) 262-1402
1111 W Broward Blvd
Ft Lauderdale, FL 33312
Phone (954) 463-7313
650 N Andrews Ave
Ft Lauderdale, FL 33311
Phone (954) 463-4213
1750 NE 167th St
North Miami Beach, FL 33162
Phone (305) 949-4000
1980 Opa Locka Blvd
Opa Locka, FL 33054
Phone (305) 681-9414
Interoperability endpoints
- gblack@direct.maniilaq.org
Organizations & group practices 6
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.
-
- Optometrist
- Ft. Lauderdale, FL
- NPI 1700924511
-
- Clinical Medical Laboratory
- Ft. Lauderdale, FL
- NPI 1770533390
-
- Family Medicine Physician
- Davie, FL
- NPI 1447345517
-
- Critical Access Hospital
- Kotzebue, AK
- NPI 1316995210
-
- Community/Behavioral Health Agency
- Kotzebue, AK
- NPI 1821297276
Hospital & facility affiliations 12
Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.
-
- Critical Access Hospital
- Kotzebue, AK
- NPI 1316995210
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1161907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1144306796",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "881 CAMELLIA CT",
"city": "PLANTATION",
"state": "FL",
"postal_code": "333171350",
"telephone_number": "954-581-7291"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 S UNIVERSITY DR",
"address_2": "NSU COLLEGE OF OPTOMETRY SUITE 1402",
"city": "DAVIE",
"state": "FL",
"postal_code": "333282018",
"telephone_number": "954-262-1402",
"fax_number": "954-262-1818"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "GREGORY",
"middle_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-10-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "FL",
"license": "OPC2975",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "620573900",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Davie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.