Shanekkia Black, MD

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

89381 Issued in GA

Practice address

1605 Mulkey Rd Ste 220
Austell, GA 30106-1127

Phone

(470) 956-3760

Fax

(678) 398-1930

NPI assigned

Apr 4, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 2

Medicare fee-for-service enrollment

Enrolled in GA

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

Specialty

Internal Medicine

Education

Morehouse School of Medicine, 2018

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Wellstar Medical Group LLCGroup PAC ID 6709065402, 3,059 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Wellstar Home Health, LLC Home health agency, Marietta, GA, CCN 117102
• Wellstar Cobb Medical Center Hospital, Austell, GA, CCN 110143
• Wellstar Douglas Medical Center Hospital, Douglasville, GA, CCN 110184
• Wellstar Kennestone Regional Medical Center Hospital, Marietta, GA, CCN 110035
• Wellstar Paulding Medical Center Hospital, Hiram, GA, CCN 110042
• Wellstar Windy Hill Hospital Long-term care hospital, Marietta, GA, CCN 112007

Merit-based Incentive Payment System (MIPS)

Final score

93.93 of 100Reported as apm

Quality

82.14

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: sblack171922@directwellstar.org

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.

• Wellstar Medical Group, LLC

  • Family Medicine Physician
  • Kennesaw, GA
  • NPI 1558664003
  Medicare reassignment Care Compare group NPD
• Wellstar Medical Group, LLC

  • Multi-Specialty Clinic/Center
  • Marietta, GA
  • NPI 1275992240
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Cobb Hospital, Inc

  • General Acute Care Hospital
  • Austell, GA
  • NPI 1467420448
  Care Compare affiliation
• Douglas Hospital, Inc.

  • General Acute Care Hospital
  • Douglasville, GA
  • NPI 1649247974
  Care Compare affiliation
• Kennestone Hospital, Inc.

  • General Acute Care Hospital
  • Marietta, GA
  • NPI 1649248626
  Care Compare affiliation
• Kennestone Hospital, Inc.

  • Long Term Care Hospital
  • Marietta, GA
  • NPI 1700853041

  Long-term care hospital

  Care Compare affiliation
• Paulding Medical Center, Inc.

  • General Acute Care Hospital
  • Hiram, GA
  • NPI 1457329435
  Care Compare affiliation
• Wellstar Home Health, LLC

  • Home Health Agency
  • Marietta, GA
  • NPI 1073591376
  Care Compare affiliation

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

{
    "created_epoch": "1522800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1681862400000",
    "number": "1164928545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1605 MULKEY RD STE 220",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061127",
            "telephone_number": "470-956-3760",
            "fax_number": "678-398-1930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1605 MULKEY RD STE 220",
            "city": "AUSTELL",
            "state": "GA",
            "postal_code": "301061127",
            "telephone_number": "470-956-3760",
            "fax_number": "678-398-1930"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3825 Medical Park Dr Ste 201",
            "address_purpose": "LOCATION",
            "city": "Austell",
            "state": "GA",
            "postal_code": "301066831",
            "country_code": "US",
            "telephone_number": "779-941-8100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "SHANEKKIA",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-04-04",
        "last_updated": "2023-04-19",
        "certification_date": "2023-04-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "GA",
            "license": "89381",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sblack171922@directwellstar.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "3825 Medical Park Dr Ste 201",
            "city": "Austell",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301066831",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "sblack171922@directwellstar.org",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "1605 Mulkey Rd Ste 220",
            "city": "Austell",
            "state": "GA",
            "country_code": "US",
            "postal_code": "301061127",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Raj Bhole, M.D.
• Bio-Medical Applications of Georgia, Inc.
• Bio-Medical Applications of Georgia, Inc.
• Catherine Tinker Bittinger, PA-C
• BJS Wholesale Club Inc
• Elizabeth P Blackwood, NP
• Amanda Puckett Blake, CNM
• Jacob Nathan Blatt, M.D.
• Sophia Antonia Blue, LPTA
• Robert M Blum, O.D.

• Internal Medicine Physician in Austell, GA
• Providers in Austell, GA by specialty
• Internal Medicine Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2023; 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.