Michael Anthony Black Sr., P.A.-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

3808 Issued in SC

Practice address

1762 E Main St
Spartanburg, SC 29307-2231

Phone

(864) 591-2261

NPI assigned

Aug 5, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in SC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2012

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Novant Health Urgent Cares LLCGroup PAC ID 8628502598, 183 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Interoperability endpoints

• FHIR API: https://epicproxy.et0939.epichosted.com/FHIRProxy/SRMYCHART/api/FHIR/R4

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.

• Novant Health Urgent Cares LLC

  • Urgent Care Clinic/Center
  • Anderson, SC
  • NPI 1841026382
  Medicare reassignment Care Compare group

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

{
    "created_epoch": "1186272000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730332800000",
    "number": "1003007311",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 749306",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303749306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1762 E MAIN ST",
            "city": "SPARTANBURG",
            "state": "SC",
            "postal_code": "293072231",
            "telephone_number": "864-591-2261"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3600 Darnall Loop",
            "address_2": "Carl R. Darnall Army Medical Center",
            "address_purpose": "LOCATION",
            "city": "Ft Hood",
            "state": "TX",
            "postal_code": "76544",
            "country_code": "US",
            "telephone_number": "254-286-7927",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "MICHAEL",
        "middle_name": "ANTHONY",
        "name_suffix": "Sr.",
        "credential": "P.A.-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-08-05",
        "last_updated": "2024-10-31",
        "certification_date": "2024-10-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WA",
            "license": "PA10004010",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "SC",
            "license": "3808",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Graycen Elizabeth Black
• James Clinton Black, MD
• Julia Black
• Mary Joan Black, MD
• Megan Black, LISW-CP
• Lauren Campbell Blackstone, BCBA
• Victoria Blackstone, MS
• Amber Nichole Blackwell
• Gail Blackwell, RN
• Samantha Marie Blackwell, NP

• Physician Assistant in Spartanburg, SC
• Providers in Spartanburg, SC by specialty
• Physician Assistant in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2024; 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.