Jeffrey Lane Black

Primary specialty

Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X

License

16468 Issued in OK

Practice address

1717 S Utica Ave Ste a
Tulsa, OK 74104-5346

Phone

(918) 748-7557

Fax

(918) 748-7514

NPI assigned

Nov 11, 2006

Last updated

Apr 13, 2010By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jeff.black@direct.stjohnhealthsystem.com

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.

• St John Urgent Care Clinics Inc

  • Urgent Care Clinic/Center
  • Tulsa, OK
  • NPI 1003918830
  NPD
• St. John Physicians, Inc

  dba Siggins Memorial Clinic

  • Rural Health Clinic/Center
  • Barnsdall, OK
  • NPI 1033176367
  NPD
• St. John Physicians, Inc.

  • Internal Medicine Physician
  • Tulsa, OK
  • NPI 1336194406
  NPD
• St John Medical Center Inc

  • Psychiatric Hospital Unit
  • Tulsa, OK
  • NPI 1144306382
  NPD (past)

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

{
    "created_epoch": "1163203200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1271116800000",
    "number": "1700957990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 N HARVARD AVE",
            "address_2": "STE E",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741154957",
            "telephone_number": "918-832-6049",
            "fax_number": "918-832-6055"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1717 S UTICA AVE STE A",
            "city": "TULSA",
            "state": "OK",
            "postal_code": "741045346",
            "telephone_number": "918-748-7557",
            "fax_number": "918-748-7514"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "JEFFREY",
        "middle_name": "LANE",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-11",
        "last_updated": "2010-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "OK",
            "license": "16468",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michael A. Blacet, LCSW-P
• Black Hawk Labs LLC
• Alyssa Crews Black, PA
• Hollie Lynn Black, D.O.
• Jamica L Black
• Jennifer Black
• Joshua Black, MD
• Leilani R Black
• Margaret Black
• Matthew John Black, MPT

• Emergency Medical Services (Emergency Medicine) Physician in Tulsa, OK
• Providers in Tulsa, OK by specialty
• Emergency Medical Services (Emergency Medicine) Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.