Jeremy Taylor Black I

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA223011 Issued in OR

Practice address

6517 Cedar Bend CT
Mobile, AL 36608-5333

Phone

(801) 842-1517

NPI assigned

Aug 9, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

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.

• Cep America LLC

  • Emergency Medicine Physician
  • Roseburg, OR
  • NPI 1780647719
  Medicare reassignment
• Cep America LLC

  • Emergency Medicine Physician
  • Coos Bay, OR
  • NPI 1063893402
  NPD
• Cep America LLC

  • Emergency Medicine Physician
  • Fort Lauderdale, FL
  • NPI 1700747946
  NPD

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

{
    "created_epoch": "1691539200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734393600000",
    "number": "1457034191",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6517 CEDAR BEND CT",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366085333",
            "telephone_number": "801-842-1517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6517 CEDAR BEND CT",
            "city": "MOBILE",
            "state": "AL",
            "postal_code": "366085333",
            "telephone_number": "801-842-1517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "JEREMY",
        "middle_name": "TAYLOR",
        "name_suffix": "I",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-08-09",
        "last_updated": "2024-12-17",
        "certification_date": "2024-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OR",
            "license": "PA223011",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gabrielle Elise Bisson
• Puspa Bahadur Bista, MD
• Quin Allain Bixler, M.D.
• Catherine Lousie Blache, RN, MSN, RNFA
• Charles Black III, D.M.D.
• Johnathan Shane Black
• Kimberly Black, HIS
• Rebecca Black, MS,CCC-SLP
• David Gerald Blackburn, MD
• Julianne Grace Blackburn, PA-C

• Physician Assistant in Mobile, AL
• Providers in Mobile, AL by specialty
• Physician Assistant in Alabama

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2024; 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.