Bradley C Black, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

011988 Issued in LA

Practice address

5220 Flanders Dr
Baton Rouge, LA 70808-9157

Phone

(225) 766-3437

Fax

(225) 766-3443

NPI assigned

Jan 10, 2007

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

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in LA

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pediatric Eye Care Center LLC

  • Ophthalmology Physician
  • Baton Rouge, LA
  • NPI 1548487846
  Medicare reassignment NPD Authorized official

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

{
    "created_epoch": "1168387200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1861541575",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5220 FLANDERS DR",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708089157",
            "telephone_number": "225-766-3437",
            "fax_number": "225-766-3443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5220 FLANDERS DR",
            "city": "BATON ROUGE",
            "state": "LA",
            "postal_code": "708089157",
            "telephone_number": "225-766-3437",
            "fax_number": "225-766-3443"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "BRADLEY",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-10",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "LA",
            "license": "011988",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1323471",
            "state": "LA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Ryann Elizabeth Bizette, OT
• Black Rhino Sports Services, Inc
• Andrew C Black, M.D.
• Anthony Black
• Beau Stephen Black, M.D.
• Caroline Black, DDS
• Chandler E Black
• Michael Black
• Selene Black, CCC-SLP, MS
• Zaniya Black

• Ophthalmology Physician in Baton Rouge, LA
• Providers in Baton Rouge, LA by specialty
• Ophthalmology Physician in Louisiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.