Dallas Black, ARNP
Individual provider Active NPI Acute Care Nurse Practitioner · Ottumwa, IA
NPI 1760156665 · NPPES record last updated Jan 21, 2022
Key facts
- NPI
- 1760156665
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Acute Care Nurse Practitioner 363LA2100X
- License
- H165013 (IA)
- Practice address
- 1011 Pennsylvania Ave
Ottumwa, IA 52501-2129 - Phone
- (641) 682-7511
- NPI assigned
- Aug 4, 2021
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Medicare Care Compare profile
- Specialty
- Nurse Practitioner
- Education
- Other, 2021
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Ottumwa Health Group LLC
Practice addresses (Care Compare)
1001 Pennsylvania Ave
Ottumwa, IA 52501-2186
Phone (641) 682-7511
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IA
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221201002845 | IA | Practitioner - Nurse Practitioner | 9931577590 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Nurse Practitioner
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Ottumwa Health Group LLC | Current |
Accepting new patients | |
| Ottumwa Health Group LLC | Current |
Accepting new patients | |
| Ottumwa Health Group LLC | Past | Accepting new patients |
Locations
1255 Theatre Dr
Ottumwa, IA 52501
Phone (641) 684-2551
1009 Pennsylvania Ave
Ottumwa, IA 52501
Phone (641) 683-4300
1013 Pennsylvania Ave
Ste E
Ottumwa, IA 52501
Phone (641) 684-3200
1011 Pennsylvania Ave
Ottumwa, IA 52501
Phone (641) 682-7511
1001 Pennsylvania Ave
Ottumwa, IA 52501
Phone (641) 472-4111
330 Seven Springs Way
Brentwood, TN 37027
Phone (615) 920-7780
Interoperability endpoints
- dallas.black.2@6270.direct.athenahealth.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Acute Care Nurse Practitioner | 363LA2100X | H165013 | IA | Yes |
Addresses
Primary practice location
1011 Pennsylvania Ave
Ottumwa, IA 52501-2129
Mailing address
PO Box 1179
Ottumwa, IA 52501-7179
Phone (319) 800-9600
Other providers in Ottumwa, IA
- Sydney Marie Bethards
- Janet Kay Bick
- Hope Marie Bitner
- Jeffrey William Bittner
- Wendy Sue Bittner
- Megan R. Blaine
- Paige Blazina
- Stanley A Blew
- Robert J Blommer
- Bloom Pediatrics of Southern Iowa PLLC
All providers in Ottumwa, IA · Acute Care Nurse Practitioner in Iowa
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 21, 2022. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.