NPIMap

Individual provider Active NPI

Jason L. Black, M.D.

  • Emergency Medicine Physician
  • Ocean Springs, MS
National Provider Identifier
1508029083
Registry record updated Jun 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
T-2070 Issued in MS
Practice address
3109 Bienville Blvd
Department of Emergency Medicine
Ocean Springs, MS 39564-4361
Phone
(228) 818-1111
NPI assigned
Jul 6, 2008
Last updated
Jun 20, 2013By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jun 20, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X T-2070 MS Primary

Addresses

Primary practice location

3109 Bienville Blvd
Department of Emergency Medicine
Ocean Springs, MS 39564-4361

Mailing address

3109 Bienville Blvd
Department of Emergency Medicine
Ocean Springs, MS 39564-4361
Phone (228) 818-1111

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MS, FL2 enrollments
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20100809000382 MS Practitioner - Emergency Medicine 6103959333 Reassigns benefits to 3 organizations
I20241004003305 FL Practitioner - Emergency Medicine 6103959333 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
University of Mississippi School of Medicine, 2008
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Memorial Hospital at GulfportGroup PAC ID 2466524012, 473 clinicians

Practice addresses (Care Compare)

4500 13TH St
Gulfport, MS 39501-2515
Phone (228) 867-5201

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
T-2070MSMDEmergency Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Emergency Room Group LTD Emergency Medicine CurrentSince Feb 15, 2015 Accepting new patients
Memorial Hospital at Gulfport Current Accepting new patients
JM Holdings of Brevard Inc CurrentSince Aug 31, 2024 Accepting new patients
Singing River Gulfport CurrentSince Mar 23, 2023 Accepting new patients
Singing River Gulfport CurrentSince Mar 23, 2023 Accepting new patients
Memorial Hospital at Gulfport Emergency Medicine CurrentSince Dec 1, 2024 Accepting new patients

Locations

1698 W Hibiscus Blvd
Ste B
Melbourne, FL 32901
Phone (321) 676-2012

350 Cowan Rd
Gulfport, MS 39507
Phone (228) 206-7054

4500 13th St
Gulfport, MS 39501
Phone (228) 236-3872

4500 13th St
#P
Gulfport, MS 39501
Phone (228) 865-3451

859 Winter St
Lucedale, MS 39452
Phone (601) 766-4286

3109 Bienville Blvd
Ocean Springs, MS 39564
Phone (228) 818-1100

2809 Denny Ave
Pascagoula, MS 39581
Phone (228) 809-5000

Interoperability endpoints

  • Direct secure messaging: jason.black.1@32269.direct.athenahealth.com

Organizations & group practices 7

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.

Hospital & facility affiliations 60

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

View all 60

NPI Registry JSON

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

{
    "created_epoch": "1215302400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1371686400000",
    "number": "1508029083",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3109 BIENVILLE BLVD",
            "address_2": "DEPARTMENT OF EMERGENCY MEDICINE",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "395644361",
            "telephone_number": "228-818-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3109 BIENVILLE BLVD",
            "address_2": "DEPARTMENT OF EMERGENCY MEDICINE",
            "city": "OCEAN SPRINGS",
            "state": "MS",
            "postal_code": "395644361",
            "telephone_number": "228-818-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "JASON",
        "middle_name": "L.",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-07-06",
        "last_updated": "2013-06-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "MS",
            "license": "T-2070",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Ocean Springs, MS

Sources for this page

Verify at the official NPI Registry.