NPIMap

Individual provider Active NPI

Janis G Black, DO

  • Family Medicine Physician
  • Cocoa, FL
National Provider Identifier
1699721548
Registry record updated Feb 25, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
OS9694 Issued in FL
Practice address
3740 Curtis Blvd
Suite 108
Cocoa, FL 32927-3962
Phone
(321) 633-5500
Fax
(321) 633-5566
NPI assigned
May 25, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 25, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X OS9694 FL Primary

Addresses

Primary practice location

3740 Curtis Blvd
Suite 108
Cocoa, FL 32927-3962

Mailing address

3740 Curtis Blvd
Suite 108
Cocoa, FL 32927-3962
Phone (321) 633-5500

Other identifiers 4

IdentifierTypeStateIssuer
275301400MedicaidFL
52558OtherFLBLUE CROSS BLUE SHIELD
8727208OtherFLCIGNA
7615827OtherFLAETNA

Other names 1

  • Dr. Janis L Gerbract Former name

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061011000647 FL Practitioner - Family Practice 7618973835 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Lake Erie College of Osteopathic Medicine, Erie, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Family Health Center at Port St John LLCGroup PAC ID 2769559749, 2 clinicians

Practice addresses (Care Compare)

3740 Curtis Blvd
Suite 108
Cocoa, FL 32927-3962
Phone (321) 633-5500

Hospital & facility affiliations

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
OS9694FLMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Family Health Center at Port St John LLC Family Medicine CurrentSince Jan 20, 2008 Accepting new patients
Hospital Authority of the City of Bainbridge and Decatur County Past Accepting new patients
North Brevard Medical Support, Inc Past Accepting new patients

Locations

3740 Curtis Blvd
Ste 108
Port St John, FL 32927
Phone (321) 633-5500

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/EIDJAA

Organizations & group practices 3

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.

Hospital & facility affiliations 6

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

NPI Registry JSON

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

{
    "created_epoch": "1148515200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1361750400000",
    "number": "1699721548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3740 CURTIS BLVD",
            "address_2": "SUITE 108",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329273962",
            "telephone_number": "321-633-5500",
            "fax_number": "321-633-5566"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3740 CURTIS BLVD",
            "address_2": "SUITE 108",
            "city": "COCOA",
            "state": "FL",
            "postal_code": "329273962",
            "telephone_number": "321-633-5500",
            "fax_number": "321-633-5566"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "JANIS",
        "middle_name": "G",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-05-25",
        "last_updated": "2013-02-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "OS9694",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "275301400",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "52558",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CIGNA",
            "identifier": "8727208",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "7615827",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JANIS",
            "last_name": "GERBRACT",
            "middle_name": "L",
            "prefix": "DR.",
            "credential": "DO",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Cocoa, FL

Sources for this page

Verify at the official NPI Registry.