Christine Marie Black, MSW LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

2008009619 Issued in MO

Practice address

1 Kwan PLZ
Potosi, MO 63664-1435

Phone

(573) 438-0751

Fax

(573) 438-5460

NPI assigned

Nov 10, 2010

Last updated

Aug 12, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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 MO

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2006

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

BJC Behavioral HealthGroup PAC ID 1153225271, shared by 2 NPIs, 63 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://epicproxy.et0965.epichosted.com/FHIRProxy/api/FHIR/DSTU2/

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.

• BJC Behavioral Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Saint Louis, MO
  • NPI 1669485868
  Medicare reassignment NPD
• BJC Behavioral Health

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Farmington, MO
  • NPI 1801807847
  Medicare reassignment NPD
• Advanced Psychiatric Services

  • Psychiatry Physician
  • Sullivan, MO
  • NPI 1457303877
  NPD (past)

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

{
    "created_epoch": "1289347200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723420800000",
    "number": "1073814828",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3309 S KINGSHIGHWAY BLVD",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631391101",
            "telephone_number": "314-206-3700",
            "fax_number": "314-206-3708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 KWAN PLZ",
            "city": "POTOSI",
            "state": "MO",
            "postal_code": "636641435",
            "telephone_number": "573-438-0751",
            "fax_number": "573-438-5460"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "CHRISTINE",
        "middle_name": "MARIE",
        "credential": "MSW LCSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-11-10",
        "last_updated": "2024-08-12",
        "certification_date": "2024-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2008009619",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "2008009619",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael Dennis Barnum, M.D.
• Timothy Will Christopher Bass, M.D.
• Kallie Belfield
• Mackenzie Bennett
• Melissa Gail Benson, LMSW
• Ronnie Dean Buckingham
• David Burke, PTA
• Jason D. Butler, FNP
• Linda D Butler, RN, BC, FNP
• Mark Byerley

• Clinical Social Worker in Potosi, MO
• Providers in Potosi, MO by specialty
• Clinical Social Worker in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 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.