NPIMap

Organization Active NPI

Black Bag Medical Inc

  • Family Medicine Physician
  • Jacksonville, FL
National Provider Identifier
1750440988
Registry record updated Jun 24, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
BLACK BAG MEDICAL INC
Practice address
4320 Deerwood Lake Pkwy
Suite 101, PMB 321
Jacksonville, FL 32216-1177
Phone
(904) 371-4051
Fax
(904) 807-4839
NPI assigned
Dec 6, 2006
Last updated
Jun 24, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 24, 2026

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

Authorized official

Name
Brian Layne Stephens, MDNPI 1295761245
Title
President
Phone
(904) 371-4051

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X NU Primary

Addresses

Primary practice location

4320 Deerwood Lake Pkwy
Suite 101, PMB 321
Jacksonville, FL 32216-1177

Mailing address

4320 Deerwood Lake Pkwy Ste 101
Jacksonville, FL 32216-1180
Phone (904) 371-4051

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20070213000591 FL Part B Supplier - Clinic/Group Practice 5698777100 Receives reassigned benefits from 17 practitioners
1 other NPI on this enrollment
Practice locations: Green Cove Springs, FL; Jacksonville, FL

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
10D1064765Black Bag Medical Inc4320 Deerwood Pkwy Ste 101 PMB 321, Jacksonville, FL 32216Certificate of waiverFeb 12, 2027

National Provider Directory

National Provider Directory

Locations

4320 Deerwood Lake Pkwy
Ste 101
Jacksonville, FL 32216
Phone (904) 371-4051

Practitioners & affiliated clinicians

Practitioners 17

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 17

NPI Registry JSON

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

{
    "created_epoch": "1165363200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1782259200000",
    "number": "1750440988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4320 DEERWOOD LAKE PKWY STE 101",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322161180",
            "telephone_number": "904-371-4051",
            "fax_number": "904-807-4839"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4320 DEERWOOD LAKE PKWY",
            "address_2": "SUITE 101, PMB 321",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322161177",
            "telephone_number": "904-371-4051",
            "fax_number": "904-807-4839"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK BAG MEDICAL INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-06",
        "last_updated": "2026-06-24",
        "certification_date": "2026-06-24",
        "status": "A",
        "authorized_official_last_name": "STEPHENS",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "LAYNE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "904-371-4051",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.