Christan Shadeene Black, AGNP-BC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

5018146 Issued in NC

Practice address

2001 Todays Woman Ave
Winston Salem, NC 27105-5069

Phone

(336) 722-1818

Fax

(336) 722-1826

NPI assigned

Jul 13, 2022

Last updated

Jun 25, 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 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NY

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, 2021

Medicare assignment

May accept Medicare assignment

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: cblack896866@direct.novanthealth.org
• Direct secure messaging: christan.black.1@32021.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.

• Team Care Medical PLLC

  • Primary Care Clinic/Center
  • Brooklyn, NY
  • NPI 1093531691
  Medicare reassignment NPD
• Novant Health Medical Group, LLC

  dba Novant Health Pediatric Neurology & Sleep

  • Neurology with Special Qualifications in Child Neurology Physician
  • Charlotte, NC
  • NPI 1366409492
  NPD

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

{
    "created_epoch": "1657670400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719273600000",
    "number": "1285368423",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2001 TODAYS WOMAN AVE",
            "city": "WINSTON SALEM",
            "state": "NC",
            "postal_code": "271055069",
            "telephone_number": "336-722-1818",
            "fax_number": "336-722-1826"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "650 East Brooklyn Avenue",
            "address_purpose": "LOCATION",
            "city": "charlotte",
            "state": "NC",
            "postal_code": "28202",
            "country_code": "US",
            "telephone_number": "540-676-0685",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "CHRISTAN",
        "middle_name": "SHADEENE",
        "name_prefix": "Ms.",
        "credential": "AGNP-BC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-07-13",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5018146",
            "primary": true
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "NC",
            "license": "2021103998",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rosemary E Bisti, CRNA
• Margaret Bistok, PHARMD
• Rhonda L Bitting, M.D.
• Keela Bittle
• Erhan Biyikli
• Chue Lee Black, PHARM D, CPP
• Eyanna Thompson Black, FNP-C
• Joel A Black Jr., DDS
• Kimberley Alyson Black
• Nickolas S Black

• Nurse Practitioner in Winston Salem, NC
• Providers in Winston Salem, NC by specialty
• Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 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.