Blacksheep Medical

Primary specialty

Health Service Clinic/CenterTaxonomy code 261QH0100X

Legal business name

BLACKSHEEP MEDICAL

Practice address

1425 Hand Ave
Suite L
Ormond Beach, FL 32174-1135

Phone

(386) 256-3977

Fax

(386) 872-5004

NPI assigned

Nov 18, 2013

Last updated

Nov 18, 2013By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Daniel A Seedor

Title

MGMR

Phone

(386) 256-3977

Specialties & licenses 1

Addresses

Tax ID family

Black Sheep Medical2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Blacksheep Medical LLC

  • Non-Pharmacy Dispensing Site
  • Ormond Beach, FL
  • NPI 1992134712
  NPD tax ID

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/20868/brand/1/csg/1/fhir/r4

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

{
    "created_epoch": "1384732800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1384732800000",
    "number": "1770913360",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1425 HAND AVE",
            "address_2": "SUITE L",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321741135",
            "telephone_number": "386-256-3977",
            "fax_number": "386-872-5004"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1425 HAND AVE",
            "address_2": "SUITE L",
            "city": "ORMOND BEACH",
            "state": "FL",
            "postal_code": "321741135",
            "telephone_number": "386-256-3977",
            "fax_number": "386-872-5004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACKSHEEP MEDICAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-11-18",
        "last_updated": "2013-11-18",
        "status": "A",
        "authorized_official_last_name": "SEEDOR",
        "authorized_official_first_name": "DANIEL",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "MGMR",
        "authorized_official_telephone_number": "386-256-3977"
    },
    "taxonomies": [
        {
            "code": "261QH0100X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Health Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mary Ellen Bing, RDN, CSR, LDN
• Bionic Prosthetics and Orthotics Group LLC
• Candies Bishop, QASP-S
• Danniele Bitton
• Harry H Black, MD
• Blacksheep Medical LLC
• Mary Beth Russo Blackwell, LCSW
• BLC Wellington-Sea, LLC (Wellington Place By The Sea)
• Rebecca L Blevins, LMHC, RN
• Bliss Sleep & Respiratory Care, Inc.

• Health Service Clinic/Center in Ormond Beach, FL
• Providers in Ormond Beach, FL by specialty
• Health Service Clinic/Center in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.