David Michael Blacklock Jr., M.D.

Primary specialty

Anesthesiology PhysicianTaxonomy code 207L00000X

License

A95723 Issued in CA

Practice address

350 Hawthorne Ave
Oakland, CA 94609-3108

Phone

(510) 655-4000

Fax

(510) 658-8593

NPI assigned

May 4, 2007

Last updated

Dec 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Anesthesiology

Education

University of Texas Medical School at Houston, 2004

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Ambulatory Consultants Medical Group IncGroup PAC ID 0446299184, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations (25 of 30)

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.

• Ambulatory Consultants Medical Group Inc

  • Anesthesiology Physician
  • Oakland, CA
  • NPI 1437178563
  Medicare reassignment Care Compare group NPD
• Anesthesia Care Associates Medical Group Inc

  • Anesthesiology Physician
  • Burlingame, CA
  • NPI 1215985023
  Medicare reassignment NPD
• Cep America - Anesthesia, PC

  • Anesthesiology Physician
  • Walnut Creek, CA
  • NPI 1790401438
  Medicare reassignment NPD
• East Bay Anesthesiology Medical Group, Inc

  • Anesthesiology Physician
  • Oakland, CA
  • NPI 1649226242
  Medicare reassignment NPD
• Pontine Incorporated

  • Anesthesiology Physician
  • San Ramon, CA
  • NPI 1053757609
  Medicare reassignment NPD
• Cep America - Anesthesia PC

  dba Vituity

  • Anesthesiology Physician
  • San Jose, CA
  • NPI 1598214108
  NPD
• Sutter Bay Medical Foundation

  dba Palo Alto Medial Foundation

  • Multi-Specialty Clinic/Center
  • Palo Alto, CA
  • NPI 1013950807
  NPD
• Sutter Bay Medical Foundation

  • Ambulatory Surgical Clinic/Center
  • Fremont, CA
  • NPI 1497996524
  NPD
• Cep America - Anesthesia PC

  • Anesthesiology Physician
  • Langhorne, PA
  • NPI 1093678229
  NPD
• Cep America - Anesthesia PC

  • Anesthesiology Physician
  • Fremont, CA
  • NPI 1982009759
  NPD (past)

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

{
    "created_epoch": "1178236800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1671580800000",
    "number": "1851503593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3173 MIRANDA AVE",
            "city": "ALAMO",
            "state": "CA",
            "postal_code": "945071610",
            "telephone_number": "415-515-4960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "350 HAWTHORNE AVE",
            "city": "OAKLAND",
            "state": "CA",
            "postal_code": "946093108",
            "telephone_number": "510-655-4000",
            "fax_number": "510-658-8593"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3875 Telegraph Ave",
            "address_purpose": "LOCATION",
            "city": "Oakland",
            "state": "CA",
            "postal_code": "946092428",
            "country_code": "US",
            "telephone_number": "510-547-2244",
            "fax_number": "510-547-6637",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1501 Trousdale Dr",
            "address_purpose": "LOCATION",
            "city": "Burlingame",
            "state": "CA",
            "postal_code": "940104506",
            "country_code": "US",
            "telephone_number": "650-696-5400",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACKLOCK",
        "first_name": "DAVID",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-04",
        "last_updated": "2022-12-21",
        "certification_date": "2022-12-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "",
            "desc": "Anesthesiology",
            "state": "CA",
            "license": "A95723",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1851503593",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sierra Autumn Black, M.A.
• Steven B. Black, MD
• Zackary Howard Black
• Blackbird Family Therapy, Inc.
• Blackbird Institute
• Alissa Blackman, LMFT
• Colleen Elizabeth Blackman
• Steven E Blackman
• Benjamin Amos Blackmon II
• Amy Elizabeth Blackshaw, MSW

• Anesthesiology Physician in Oakland, CA
• Providers in Oakland, CA by specialty
• Anesthesiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 21, 2022; 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.
• 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.