Jason L. Black, M.D.
Individual provider Active NPI Emergency Medicine Physician · Ocean Springs, MS
NPI 1508029083 · NPPES record last updated Jun 20, 2013
Key facts
- NPI
- 1508029083
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- License
- T-2070 (MS)
- Practice address
- 3109 Bienville Blvd
Department of Emergency Medicine
Ocean Springs, MS 39564-4361 - Phone
- (228) 818-1111
- NPI assigned
- Jul 6, 2008
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 7
Hospital & facility affiliations 60
Medicare Care Compare profile
- 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 Gulfport
Practice addresses (Care Compare)
4500 13TH St
Gulfport, MS 39501-2515
Phone (228) 867-5201
Hospital & facility affiliations
- Memorial Hospital Biloxi
- Memorial Hospital at Gulfport
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled (2 enrollments) in MS, FL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20100809000382 | MS | Practitioner - Emergency Medicine | 6103959333 | Reassigns benefits to 3 organizations |
| I20241004003305 | FL | Practitioner - Emergency Medicine | 6103959333 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| T-2070 | MS | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| JM Holdings of Brevard Inc | Current |
Accepting new patients | |
| Singing River Gulfport | Current |
Accepting new patients | |
| Memorial Hospital at Gulfport | Emergency Medicine | Current |
Accepting new patients |
| Singing River Gulfport | Current |
Accepting new patients | |
| Memorial Hospital at Gulfport | Current | Accepting new patients | |
| Emergency Room Group LTD | Emergency Medicine | Current |
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
#P
Gulfport, MS 39501
Phone (228) 865-3451
4500 13th St
Gulfport, MS 39501
Phone (228) 236-3872
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
- jason.black.1@32269.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | T-2070 | MS | Yes |
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
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20838 | Other | MS | PERMANENT LICENSE NUMBER |
Other providers in Ocean Springs, MS
- Bienville Medical Clinic, PLLC
- Melanie Billman
- Biloxi OBGYN Clinic, PA
- Laci Marie Bishop
- Stephanie Sowell Bishop
- Kelly Black
- Angela Rene Blackman
- Shelby Marie Blades
- Kristen Blair
- Alexander Drake Blevens
All providers in Ocean Springs, MS · Emergency Medicine Physician in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 20, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.