Daniel T Black, DO
Individual provider Active NPI Family Medicine Physician · Sale Creek, TN
NPI 1194726604 · NPPES record last updated Sep 12, 2007
Key facts
- NPI
- 1194726604
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- DO1671 (TN)
- Practice address
- 108 Griffith St
Sale Creek, TN 37373-9715 - Phone
- (423) 332-1813
- Fax
- (423) 332-7732
- NPI assigned
- Aug 9, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Hospital & facility affiliations 5
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- West Virginia School of Osteopathic Medicine, 2002
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
108 Griffith St
Sale Creek, TN 37373-9715
Phone (423) 332-1813
Hospital & facility affiliations
- Amedisys Home Health Chattanooga
- Rhea Medical Center
- Memorial Healthcare System, Inc
- Erlanger Medical Center
Procedures performed for Medicare patients
| Procedure | Number of procedures |
|---|---|
| Melanoma (skin cancer) excision | 1-10 |
| Removal of skin lesions | 16 |
| Removal of nail tissue | 1-10 |
| Removal or shaving of skin growth | 1-10 |
| Skin biopsy | 1-10 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TN
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20050718000038 | TN | Practitioner - Family Practice | 4183675556 |
Reassigns benefits to 1 organization Practice locations: Dayton, TN |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy, Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DO1671 | TN | MD | Family Medicine Physician |
| 1671 | TN | MD | Surgical Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sale Creek Family Practice, PLLC | Family Medicine | Current |
Accepting new patients |
| Daniel T Black | Family Medicine | Past | Accepting new patients |
Locations
108 Griffith St
Sale Creek, TN 37373
Phone (423) 332-1813
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | DO1671 | TN | Yes |
Addresses
Primary practice location
108 Griffith St
Sale Creek, TN 37373-9715
Mailing address
PO Box 667
108 Griffith St
Sale Creek, TN 37373-0667
Phone (423) 332-1813
Other providers in Sale Creek, TN
- Agilitas USA, Inc
- Christa M Byerley
- Brittany L Cannon
- Michael Caraccio
- Julie Elizabeth Carr
- Rachel Clark
All providers in Sale Creek, TN · Family Medicine Physician in Tennessee
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 12, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.