John Alan Black, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

149.019644 Issued in IL

Practice address

8401 Crawford Ave Ste 106
Skokie, IL 60076-2154

Phone

(847) 423-2625

Fax

(847) 737-1663

NPI assigned

Nov 24, 2010

Last updated

Mar 17, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in TX

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, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Martin Luther King Jr Family ClinicGroup PAC ID 1456248673, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: john.black.1@17390.direct.athenahealth.com

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.

• Martin Luther King Jr Family Clinic

  • Federally Qualified Health Center (FQHC)
  • Dallas, TX
  • NPI 1851492557
  Medicare reassignment Care Compare group NPD
• Dallas County Mental Health & Mental Retardation Center

  dba Metrocare Services

  • Psychiatry Physician
  • Dallas, TX
  • NPI 1023239886
  NPD (past)

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

{
    "created_epoch": "1290556800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1225330277",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1881 OAK AVE APT 410W",
            "city": "EVANSTON",
            "state": "IL",
            "postal_code": "602017400",
            "telephone_number": "702-334-9755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8401 CRAWFORD AVE STE 106",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600762154",
            "telephone_number": "847-423-2625",
            "fax_number": "847-737-1663"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "107 S High St",
            "address_purpose": "LOCATION",
            "city": "Antlers",
            "state": "OK",
            "postal_code": "745233818",
            "country_code": "US",
            "telephone_number": "580-298-2830",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "JOHN",
        "middle_name": "ALAN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-11-24",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "OK",
            "license": "4135",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TX",
            "license": "56085",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149.019644",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brittany Bidlack
• Liana K Billings, MD, MMSC
• Marina A Birman, PA-C
• Brendan Birmingham, BCBA
• BJG MD SC (Eye Physicians Glasses)
• Julie Blackman, L.C.S.W.
• Joy Ellen Blair, MS OTRL
• Blan Haven LLC
• Michael Gene Blankespoor, MD
• Brian J Blazek, MS BCBA

• Clinical Social Worker in Skokie, IL
• Providers in Skokie, IL by specialty
• Clinical Social Worker in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.