Charles Dewayne Black, D.O.

Primary specialty

Emergency Medical Services (Emergency Medicine) PhysicianTaxonomy code 207PE0004X

License

3023 Issued in OK

Practice address

1011 14TH Ave NW
ER Dept.
Ardmore, OK 73401-1828

Phone

(580) 220-6415

Fax

(405) 749-4561

NPI assigned

Apr 5, 2006

Last updated

Nov 9, 2007By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in OK

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 Osteopathy

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Exceptional Physicians Group Ardmore Hospital PLLC

  • Emergency Medicine Physician
  • Ardmore, OK
  • NPI 1588427462

  Emergency Medical Services

  Medicare reassignment NPD
• Nes Oklahoma, Inc.

  • Emergency Medicine Physician
  • Ponca City, OK
  • NPI 1528040722
  Medicare reassignment NPD
• Oklahoma Emergency Physician Partners PLLC

  • Emergency Medicine Physician
  • Durant, OK
  • NPI 1891039764
  NPD
• Ehc Ardmore LLC

  dba Exceptional Community Hospital Ardmore

  • General Acute Care Hospital
  • Ardmore, OK
  • NPI 1023754793
  NPD (past)
• Marshall County Hma, LLC

  dba AllianceHealth Madill

  • Critical Access Hospital
  • Madill, OK
  • NPI 1467476556
  NPD (past)

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

{
    "created_epoch": "1144195200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1194566400000",
    "number": "1891757860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4401 W MEMORIAL RD",
            "address_2": "SUITE 121",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "731341785",
            "telephone_number": "405-751-4664",
            "fax_number": "405-749-4561"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 14TH AVE NW",
            "address_2": "ER DEPT.",
            "city": "ARDMORE",
            "state": "OK",
            "postal_code": "734011828",
            "telephone_number": "580-220-6415",
            "fax_number": "405-749-4561"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "CHARLES",
        "middle_name": "DEWAYNE",
        "credential": "D.O.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-05",
        "last_updated": "2007-11-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207PE0004X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine, Emergency Medical Services",
            "state": "OK",
            "license": "3023",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Judith M Billingsley
• Kenneth L Billingsley
• Crystal Birchfield
• Emma Bishop
• Tricia Ann Bivens, LPC
• Kalie Blackbear
• Karie Blackwell
• Brandy Lee Blackwood
• Blake Bush Family Eyecare Inc.
• Mikaela Blakemore

• Emergency Medical Services (Emergency Medicine) Physician in Ardmore, OK
• Providers in Ardmore, OK by specialty
• Emergency Medical Services (Emergency Medicine) Physician in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 9, 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.