Jason L Black, APRN-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

12510 Issued in TN

Practice address

1407 W Baddour Pkwy
Lebanon, TN 37087-2513

Phone

(615) 444-6203

Fax

(615) 444-6252

NPI assigned

May 9, 2008

Sex

Male

Sole proprietor

No

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.

• Family Medical PC

  • Specialist
  • Lebanon, TN
  • NPI 1295805794

  TN

  Medicare reassignment Care Compare group
• Icco, LLC

  • Urgent Care Clinic/Center
  • Eugene, OR
  • NPI 1407004757

  OR

  Medicare reassignment NPD
• QV Urgent Care Ia PLLC

  • Urgent Care Clinic/Center
  • Mt. Pleasant, IA
  • NPI 1407465917

  IA

  Medicare reassignment NPD
• QV Urgent Care TX PLLC

  • Family Medicine Physician
  • Henderson, TX
  • NPI 1568098887

  TX

  Medicare reassignment NPD
• Southern Immediate Care, LLC

  • Urgent Care Clinic/Center
  • Anniston, AL
  • NPI 1467909978

  AL

  Medicare reassignment NPD
• Stopwatch Urgent Care Centers LLC

  • Urgent Care Clinic/Center
  • Auburn, AL
  • NPI 1841506458

  AL

  Medicare reassignment NPD
• Icco LLC

  • Rural Health Clinic/Center
  • Florence, OR
  • NPI 1740896547
  NPD
• QV Urgent Care Ia PLLC

  • Rural Health Clinic/Center
  • Washington, IA
  • NPI 1235835950
  NPD
• QV Urgent Care TX PLLC

  • Rural Health Clinic/Center
  • Madisonville, TX
  • NPI 1669198347
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• HCA Health Services of Tennessee, Inc.

  • General Acute Care Hospital
  • Hermitage, TN
  • NPI 1982650024

  Hospital

  Care Compare affiliation
• Vanderbilt University Medical Center

  • General Acute Care Hospital
  • Lebanon, TN
  • NPI 1306889597

  Hospital

  Care Compare affiliation

Specialty

Nurse Practitioner

Education

Vanderbilt University School of Medicine, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Family Medical PC 13 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Tristar Summit Medical Center Hospital, Hermitage, TN, CCN 440150
• Vanderbilt Wilson County Hospital Hospital, Lebanon, TN, CCN 440193

Medicare fee-for-service enrollment

Enrolled in TN, TX, IA, OR, AL5 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 5

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/17814/brand/1/csg/1/fhir/r4

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

Specialties & licenses 2

Addresses

Other identifiers 9

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jun 11, 2020.

{
    "created_epoch": "1210291200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1591833600000",
    "number": "1306013305",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1407 W BADDOUR PKWY",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370872513",
            "telephone_number": "615-444-6203",
            "fax_number": "615-444-6252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1407 W BADDOUR PKWY",
            "city": "LEBANON",
            "state": "TN",
            "postal_code": "370872513",
            "telephone_number": "615-444-6203",
            "fax_number": "615-444-6252"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1600 US Highway 79 S",
            "address_purpose": "LOCATION",
            "city": "Henderson",
            "state": "TX",
            "postal_code": "756544508",
            "country_code": "US",
            "telephone_number": "903-717-3260",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "JASON",
        "middle_name": "L",
        "name_prefix": "Mr.",
        "credential": "APRN-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2008-05-09",
        "last_updated": "2020-06-11",
        "certification_date": "2020-06-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TX",
            "license": "AP145757",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "TN",
            "license": "12510",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1524683",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "270851352",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "4298132",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "1671330",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TN REGISTERED NURSE",
            "identifier": "141492",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHC",
            "identifier": "3323078",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CAQH",
            "identifier": "12242516",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRICARE",
            "identifier": "62-1792161",
            "state": "TN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ADVANCED PRACTICE NURSE NUMBER",
            "identifier": "12510",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sydney Victoria Berry, OD
• Best Care Services
• Irene Florence Bible, M.S.,CCC-SLP
• Adelia Lee Birdwell, PA-C
• Vaibhav Singh Bisht
• Jennifer Rose Black
• Matthew Elisha Black
• Kristy M Blaney, RN, APRN
• Jaime Christen Blaylock, APRN-C
• Laura F Boggan, MS NCP

• All providers in Lebanon, TN
• Family Nurse Practitioner in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 11, 2020; 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.

Verify at the official NPI Registry.