Active NPI
Bradley C Black, MD
- Ophthalmology Physician
- Jeffersonville, IN
National Provider Identifier
1356347884
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- 01027732A
- Practice address
- 302 W 14TH St
Ste 100
Jeffersonville, IN 47130-3751 - Phone
- (812) 284-0660
- Fax
- (812) 284-3822
- NPI assigned
- Jun 21, 2005
- 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 |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 01027732A | IN | Primary |
Addresses
Primary practice location
302 W 14TH St
Ste 100
Jeffersonville, IN 47130-3751
Mailing address
302 W 14TH St
Ste 100
Jeffersonville, IN 47130-3751
Phone (812) 284-0660
Other identifiers 14
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 351995025 | Other | HUMANA | |
| 4114033 | Other | FIRST HEALTH | |
| 000000042712 | Other | ANTHEM | |
| 1051940 | Other | KY | PASSPORT |
| 351995025 | Other | SAGAMORE | |
| 4114033 | Other | AETNA | |
| 245535P | Other | SIHO | |
| 918528 | Other | BLOCK VISION | |
| 100116130 | Medicaid | IN | |
| 690178 | Other | FIRST HEALTH | |
| 33654 | Other | IHN | |
| 351995025 | Other | UNITED HEALTHCARE | |
| 351995025 | Other | CIGNA | |
| 64755762 | Other | KY | UNISYS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Eye Associates of Southern Indiana PC | Ophthalmology | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Ophthalmology Physician
- Jeffersonville, IN
- NPI 1336219922
-
- Durable Medical Equipment & Medical Supplies
- New Albany, IN
- NPI 1083607592
Ophthalmology
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119312000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210550400000",
"number": "1356347884",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "302 W 14TH ST",
"address_2": "STE 100",
"city": "JEFFERSONVILLE",
"state": "IN",
"postal_code": "471303751",
"telephone_number": "812-284-0660",
"fax_number": "812-284-3822"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "302 W 14TH ST",
"address_2": "STE 100",
"city": "JEFFERSONVILLE",
"state": "IN",
"postal_code": "471303751",
"telephone_number": "812-284-0660",
"fax_number": "812-284-3822"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "BRADLEY",
"middle_name": "C",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-21",
"last_updated": "2008-05-12",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "IN",
"license": "01027732A",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "HUMANA",
"identifier": "351995025",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH",
"identifier": "4114033",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTHEM",
"identifier": "000000042712",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PASSPORT",
"identifier": "1051940",
"state": "KY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SAGAMORE",
"identifier": "351995025",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "AETNA",
"identifier": "4114033",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SIHO",
"identifier": "245535P",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLOCK VISION",
"identifier": "918528",
"state": null
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "100116130",
"state": "IN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FIRST HEALTH",
"identifier": "690178",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "IHN",
"identifier": "33654",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNITED HEALTHCARE",
"identifier": "351995025",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "351995025",
"state": null
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "UNISYS",
"identifier": "64755762",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Jeffersonville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2008; 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.