BLACK OAK CLINIC LLC
NPI 1366954661
Clinic/Center in Broken Bow, OK
About Black Oak Clinic Llc NPPES
Official registry information on file with the National Plan and Provider Enumeration System.
BLACK OAK CLINIC LLC (NPI 1366954661) is a healthcare organization registered as a clinic/center in Broken Bow, Oklahoma and active in the NPI registry since October 2017. The organization lists Megan Elizabeth Black, Owner/nurse Practitioner, as its authorized official.
NPPES Registry Identity
Specialties & Licenses
Other Identifiers 1
Medicare Participation & PECOS CMS
Medicare enrollment and the clinicians who bill Medicare through this organization, from CMS.
Medicare Enrollment Status
Enrolled in Medicare (PECOS)
Black Oak Clinic Llc is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).
Clinicians Billing Medicare Through This Organization
Medicare enrollment records show 1 clinician reassigns Medicare billing to Black Oak Clinic LLC, which bills Medicare for the services this clinician delivers.
Clinician (1)
Source: CMS Revalidation Reassignment List, October 2026 release. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
Frequently Asked Questions NPPES & CMS
Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.
What is Black Oak Clinic LLC's NPI number?
The NPI number for Black Oak Clinic LLC is 1366954661. It was assigned to this organization in the NPPES registry on October 26, 2017.
Where is Black Oak Clinic LLC located?
Black Oak Clinic LLC is located at 110 W 1st St, Broken Bow, OK 74728. The listed phone number is (580) 584-3099.
What is Black Oak Clinic LLC's specialty?
The primary specialty registered for this NPI is Clinic/Center with taxonomy code 261Q00000X.
Is Black Oak Clinic LLC enrolled in Medicare?
Yes. Black Oak Clinic LLC is registered in the Medicare PECOS enrollment system.
How many clinicians bill Medicare through Black Oak Clinic LLC?
According to the CMS Revalidation Reassignment List (October 2026 release), 1 clinician (Nurse Practitioner) reassigns their Medicare billing to Black Oak Clinic LLC. A reassignment is filed with Medicare on form CMS-855R, signed by both the clinician and the organization, and lets the organization bill Medicare and receive payment for the clinician's services. Reassignment records can lag staffing changes; confirm a current affiliation with the organization.
When was this NPI record last updated?
The NPPES record for Black Oak Clinic LLC was last updated on August 7, 2018. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 8 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.
# Black Oak Clinic Llc · NPI 1366954661
Clinic/Center organization in Broken Bow, Oklahoma. Organization record, active in the CMS NPPES registry since October 26, 2017.
## Identity
- **NPI:** 1366954661 (Entity type: Organization)
- **Enumerated:** October 26, 2017
- **Primary specialty:** Clinic/Center · taxonomy 261Q00000X
- **Organization subpart:** No
- **Authorized official:** Megan Black, OWNER/NURSE PRACTITIONER
## Practice location
- **Address:** 110 W 1ST ST, Broken Bow, OK 74728
- **Phone:** (580) 584-3099 · **Fax:** (580) 584-3097
## Medicare
- **Medicare:** Enrolled in Medicare (PECOS)
- **Clinicians billing through this organization:** 1 clinician (Nurse Practitioner) reassigns Medicare billing to this organization (form CMS-855R) · CMS Revalidation Reassignment List, October 2026 release
## Record status
- **NPPES last updated:** August 7, 2018
- **Other identifiers:** Medicaid 200740450A (OK)
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Source: [NPI Profile](https://npiprofile.com/npi/1366954661) · Data from the CMS NPPES public registry.