Austin Harbor Black, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

906272 Issued in MS

Practice address

5681 Highway 363
Mantachie, MS 38855-7632

Phone

(662) 282-4226

NPI assigned

Sep 13, 2023

Last updated

Sep 13, 2023By 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 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MS

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

Nurse Practitioner

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Mantachie Rural Health Care, IncGroup PAC ID 2567372121, 12 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Bachelor of Science, Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://fhir4.healow.com/fhir/r4/IIBHBA

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.

• Mantachie Rural Health Care, Inc

  dba Mantachie Clinic

  • Family Medicine Physician
  • Mantachie, MS
  • NPI 1033169545
  Medicare reassignment Care Compare group NPD
• Mantachie Rural Health Care, Inc

  dba Dorsey Family Medical Center

  • Federally Qualified Health Center (FQHC)
  • Fulton, MS
  • NPI 1508652330
  NPD
• Mantachie Rural Health Care, Inc

  dba Mantachie Rural Health Care, Inc. Dorsey School

  • Federally Qualified Health Center (FQHC)
  • Fulton, MS
  • NPI 1447031943
  NPD (past)
• Mantachie Rural Health Care, Inc. Dental

  • Federally Qualified Health Center (FQHC)
  • Mantachie, MS
  • NPI 1063779130
  NPD (past)

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

{
    "created_epoch": "1694563200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694563200000",
    "number": "1245017052",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40",
            "city": "MANTACHIE",
            "state": "MS",
            "postal_code": "388550040",
            "telephone_number": "662-282-4226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5681 HIGHWAY 363",
            "city": "MANTACHIE",
            "state": "MS",
            "postal_code": "388557632",
            "telephone_number": "662-282-4226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "AUSTIN",
        "middle_name": "HARBOR",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-09-13",
        "last_updated": "2023-09-13",
        "certification_date": "2023-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "MS",
            "license": "906272",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Emily Bass, COTA/L
• Timmi Unger Bishop, MS, RD, LD
• Hannah Grace Boren, FNP-C
• Andrea Carpenter, FNP-C
• Madison Leigh Carrell, FNP-C
• Nativel J Collins, CFNP
• Community Family Healthcare, Inc

• Family Nurse Practitioner in Mantachie, MS
• Providers in Mantachie, MS by specialty
• Family Nurse Practitioner in Mississippi

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 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.