NPIMap

Individual provider Active NPI

Connor Black, DO

  • Emergency Medicine Physician
  • Fort Lauderdale, FL
National Provider Identifier
1669176160
Registry record updated May 11, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Emergency Medicine PhysicianTaxonomy code 207P00000X
License
06250 Issued in KY
Practice address
1600 S Andrews Ave
Fort Lauderdale, FL 33316-2510
Phone
(954) 355-4400
NPI assigned
Mar 28, 2023
Last updated
May 11, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 11, 2026

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Emergency Medicine Physician 207P00000X 06250 KY Primary
Emergency Medicine Physician 207P00000X 4451 AL

Addresses

Primary practice location

1600 S Andrews Ave
Fort Lauderdale, FL 33316-2510

Mailing address

2452 NW Columbia Ave Unit 11
East Wenatchee, WA 98802-4198

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in AL, KY2 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
I20260507002297 AL Practitioner - Emergency Medicine 1254809213 Reassigns benefits to 1 organization
I20260616002896 KY Practitioner - Emergency Medicine 1254809213

Care Compare profile

Medicare Care Compare
Specialty
Emergency Medicine
Education
Other, 2023
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Southeastern Emergency Physicians LLCGroup PAC ID 2466364997, 776 clinicians

Practice addresses (Care Compare)

1301 N Race St
Glasgow, KY 42141-3454
Phone (270) 651-4100

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
06250KYMDEmergency Medicine Physician
4451ALMDPediatric Occupational Therapist

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 22

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

View all 22

NPI Registry JSON

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

{
    "created_epoch": "1679961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1778457600000",
    "number": "1669176160",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2452 NW COLUMBIA AVE UNIT 11",
            "city": "EAST WENATCHEE",
            "state": "WA",
            "postal_code": "988024198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 S ANDREWS AVE",
            "city": "FORT LAUDERDALE",
            "state": "FL",
            "postal_code": "333162510",
            "telephone_number": "954-355-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "CONNOR",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2023-03-28",
        "last_updated": "2026-05-11",
        "certification_date": "2026-05-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "KY",
            "license": "06250",
            "primary": true
        },
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "AL",
            "license": "4451",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Lauderdale, FL

Sources for this page

Verify at the official NPI Registry.