NPIMap

Individual provider Active NPI

Austin C. Black, AU.D.

  • Audiologist
  • Crestview, FL
National Provider Identifier
1861585978
Registry record updated Oct 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
AudiologistTaxonomy code 231H00000X
License
0388 Issued in KY
Practice address
2670 S Ferdon Blvd Ste 105
Crestview, FL 32536-5481
Phone
(850) 683-8777
NPI assigned
Oct 2, 2006
Last updated
Oct 24, 2023By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 24, 2023

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Audiologist 231H00000X 0388 KY Primary
Assistive Technology Practitioner Audiologist 231HA2400X 0388 KY
Assistive Technology Supplier Audiologist 231HA2500X 0388 KY
Audiologist-Hearing Aid Fitter 237600000X 0388 KY

Addresses

Primary practice location

2670 S Ferdon Blvd Ste 105
Crestview, FL 32536-5481

Mailing address

2670 S Ferdon Blvd Ste 105
Crestview, FL 32536-5481
Phone (850) 683-8777

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
0388KYMDAssistive Technology Supplier Audiologist

Practice roles

OrganizationSpecialtyStatusNew patients
Hearusa Inc Audiologist-Hearing Aid Fitter Past Accepting new patients
ENT Care Centers PLLC PastSince Apr 1, 2022 Accepting new patients
Simetria Audiologist Past Accepting new patients
Audiology Distribution, LLC Audiologist-Hearing Aid Fitter Past Accepting new patients
Kentuckiana Ear, Nose & Throat PSC PastSince Feb 10, 1995 Accepting new patients
University Surgical Associates, PSC Audiologist Past Accepting new patients
Hear Here LLC Audiologist Past Accepting new patients

Organizations & group practices 7

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.

NPI Registry JSON

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

{
    "created_epoch": "1159747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698105600000",
    "number": "1861585978",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2670 S FERDON BLVD STE 105",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325365481",
            "telephone_number": "850-683-8777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2670 S FERDON BLVD STE 105",
            "city": "CRESTVIEW",
            "state": "FL",
            "postal_code": "325365481",
            "telephone_number": "850-683-8777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "AUSTIN",
        "middle_name": "C.",
        "name_prefix": "Dr.",
        "credential": "AU.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-02",
        "last_updated": "2023-10-24",
        "certification_date": "2023-10-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "231H00000X",
            "taxonomy_group": "",
            "desc": "Audiologist",
            "state": "KY",
            "license": "0388",
            "primary": true
        },
        {
            "code": "231HA2400X",
            "taxonomy_group": "",
            "desc": "Audiologist, Assistive Technology Practitioner",
            "state": "KY",
            "license": "0388",
            "primary": false
        },
        {
            "code": "231HA2500X",
            "taxonomy_group": "",
            "desc": "Audiologist, Assistive Technology Supplier",
            "state": "KY",
            "license": "0388",
            "primary": false
        },
        {
            "code": "237600000X",
            "taxonomy_group": "",
            "desc": "Audiologist-Hearing Aid Fitter",
            "state": "KY",
            "license": "0388",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Crestview, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 24, 2023; 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.