Keith N Black, DO

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

E9543 Issued in TX

Practice address

421 Main Street
Panhandle, TX 79068

Phone

(806) 532-2273

Fax

(806) 532-2276

NPI assigned

Jul 26, 2006

Last updated

Mar 1, 2012By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 9

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/25616/brand/1/csg/1/fhir/r4

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

• Family Medicine Center of Pampa PLLC

  • Family Medicine Physician
  • Pampa, TX
  • NPI 1174556187
  NPD
• Family Medicine Centers Lab L P

  • Clinical Medical Laboratory
  • Amarillo, TX
  • NPI 1972515765
  NPD (past)
• Panhandle Family Care LLC

  dba Family Care Clinic of Panhandle

  • Rural Health Clinic/Center
  • Panhandle, TX
  • NPI 1003407834
  NPD (past)

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1330560000000",
    "number": "1386668267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10",
            "city": "PANHANDLE",
            "state": "TX",
            "postal_code": "790680010",
            "telephone_number": "806-532-2273",
            "fax_number": "806-532-2276"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "421 MAIN STREET",
            "city": "PANHANDLE",
            "state": "TX",
            "postal_code": "79068",
            "telephone_number": "806-532-2273",
            "fax_number": "806-532-2276"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "KEITH",
        "middle_name": "N",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-26",
        "last_updated": "2012-03-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "TX",
            "license": "E9543",
            "primary": true
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OK",
            "license": "1793",
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "VT",
            "license": "0320000253",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "FIRST CARE",
            "identifier": "108684100",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "80138267",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA DMERC",
            "identifier": "1186100001",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "131469204",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PALMETTO DMERC",
            "identifier": "1186100001",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WORKER'S COMPENSATION",
            "identifier": "E9543",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "SOUTHWEST LIFE & HEALTH",
            "identifier": "132180100",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "84V315",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNICARE",
            "identifier": "E9543",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Advanced Biogenetics and Life Sciences, LLC
• Ajay Ray Bonner
• Brandi Nicole Brame, LPC
• Larissa Brice
• Kaylin Dawn Chase-Henley, FNP-C
• City of Panhandle (Panhandle EMS)

• Family Medicine Physician in Panhandle, TX
• Providers in Panhandle, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.