Active NPI
Thomas C Black, MD
- Ophthalmology Physician
- Kansas City, MO
National Provider Identifier
1689691180
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Ophthalmology Physician
- License
- R3026
- Practice address
- 1010 Carondelet Dr
Suite 103
Kansas City, MO 64114-4821 - Phone
- (816) 942-8008
- Fax
- (816) 942-5314
- NPI assigned
- Jul 17, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | R3026 | MO | Primary |
Addresses
Primary practice location
1010 Carondelet Dr
Suite 103
Kansas City, MO 64114-4821
Mailing address
1010 Carondelet Dr
Suite 103
Kansas City, MO 64114-4821
Phone (816) 942-8008
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04192051 | Other | BLUE CROSS BLUE SHIELD |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153094400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1689691180",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1010 CARONDELET DR",
"address_2": "SUITE 103",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641144821",
"telephone_number": "816-942-8008",
"fax_number": "816-942-5314"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1010 CARONDELET DR",
"address_2": "SUITE 103",
"city": "KANSAS CITY",
"state": "MO",
"postal_code": "641144821",
"telephone_number": "816-942-8008",
"fax_number": "816-942-5314"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "THOMAS",
"middle_name": "C",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-17",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "207W00000X",
"taxonomy_group": "",
"desc": "Ophthalmology",
"state": "MO",
"license": "R3026",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "04192051",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Kansas City, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.