Michael Vincent Black, PA-C, ATC

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

023345 Issued in NY

Practice address

541 E 71St St FL 1
New York, NY 10021-4871

Phone

(646) 797-8735

Fax

(646) 797-8726

NPI assigned

Jan 7, 2019

Sex

Male

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 3

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

Physician Assistant

Education

Other, 2019

Medicare assignment

May accept Medicare assignment

Group practices

Lawrence V. Gulotta MD PCGroup PAC ID 0547497141, 2 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Hospital for Special Surgery Hospital, New York, NY, CCN 330270

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2
• Direct secure messaging: mblack105357@direct.hss.edu
• FHIR API: https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/

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.

• Lawrence V. Gulotta MD PC

  • Orthopaedic Surgery Physician
  • New York, NY
  • NPI 1881036515
  Medicare reassignment Care Compare group
• New York Society for the Relief of Ruptured & Crippled Maintaining

  • Special Hospital
  • New York, NY
  • NPI 1427496652
  Medicare reassignment
• Danyal Nawabi MD PC

  • Sports Medicine (Orthopaedic Surgery) Physician
  • New York, NY
  • NPI 1326777228
  NPD
• New York Society for Releif of the Ruptured and Crippled Maintaining

  • Special Hospital
  • New York, NY
  • NPI 1477988707
  NPD
• New York Society for the Relief of Ruptured & Crippled Maintaining

  • Specialist
  • Paramus, NJ
  • NPI 1417357849
  NPD
• New York Society for the Relief of Ruptured & Crippled Maintaining

  • General Acute Care Hospital
  • New York, NY
  • NPI 1598703019
  NPD (past)

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

• HSS Westchester

  • Radiology Clinic/Center
  • White Plains, NY
  • NPI 1184159188

  Hospital

  Care Compare affiliation
• New York Society for Relief of the Ruptured and Crippled Maintaining T

  • Radiology Clinic/Center
  • New York, NY
  • NPI 1376032029

  Hospital

  Care Compare affiliation
• New York Society for Relief of the Ruptured and Crippled Maintaining T

  • Radiology Clinic/Center
  • Brooklyn, NY
  • NPI 1487200408

  Hospital

  Care Compare affiliation
• New York Society for Relief of the Ruptured and Crippled Maintaining T

  • Radiology Clinic/Center
  • New York, NY
  • NPI 1801443619

  Hospital

  Care Compare affiliation
• New York Society for the Relief of Ruptured & Crippled Maintaining

  • Radiology Clinic/Center
  • Southampton, NY
  • NPI 1023705803

  Hospital

  Care Compare affiliation
• New York Society for the Relief of Ruptured & Crippled Maintaining

  • General Acute Care Hospital
  • New York, NY
  • NPI 1598703019
  Care Compare affiliation
• New York Society for the Relief of the Ruptured and Crippled

  • Radiology Clinic/Center
  • Uniondale, NY
  • NPI 1629504501

  Hospital

  Care Compare affiliation
• New York Society for the Relief of Ruptured & Crippled Maintaining

  • General Acute Care Hospital
  • Paramus, NJ
  • NPI 1447082003
  Care Compare affiliation
• New York Society for the Relief of the Ruptured and Crippled

  • General Acute Care Hospital
  • Paramus, NJ
  • NPI 1184038663
  Care Compare affiliation
• New York Society for the Relief of the Ruptured and Crippled

  • Radiology Clinic/Center
  • Stamford, CT
  • NPI 1821402306

  Hospital

  Care Compare affiliation

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

{
    "created_epoch": "1546819200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1730419200000",
    "number": "1376016873",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "535 E 70TH ST",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100214823",
            "telephone_number": "646-797-8735",
            "fax_number": "646-797-8726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "541 E 71ST ST FL 1",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "100214871",
            "telephone_number": "646-797-8735",
            "fax_number": "646-797-8726"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1133 Westchester Ave",
            "address_purpose": "LOCATION",
            "city": "White Plains",
            "state": "NY",
            "postal_code": "106043516",
            "country_code": "US",
            "telephone_number": "646-797-8735",
            "fax_number": "646-797-8726",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "535 E 70th St",
            "address_purpose": "LOCATION",
            "city": "New York",
            "state": "NY",
            "postal_code": "100214823",
            "country_code": "US",
            "telephone_number": "646-797-8735",
            "fax_number": "646-797-8726",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "MICHAEL",
        "middle_name": "VINCENT",
        "credential": "PA-C, ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-01-07",
        "last_updated": "2024-11-01",
        "certification_date": "2024-11-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "NY",
            "license": "002248",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NY",
            "license": "023345",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mblack105357@direct.HSS.edu",
            "affiliation": "N",
            "endpointDescription": "direct messaging address",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "other",
            "address_1": "535 E 70th St",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100214823",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/R4/",
            "affiliation": "N",
            "endpointDescription": "current FHIR URL",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "535 E 70th St",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100214823",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "FHIR",
            "endpointTypeDescription": "FHIR URL",
            "endpoint": "https://epicproxy.et0927.epichosted.com/FHIRProxy/api/FHIR/DSTU2",
            "affiliation": "N",
            "endpointDescription": "legacy FHIR URL",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "CCDA",
            "address_1": "535 E 70th St",
            "city": "New York",
            "state": "NY",
            "country_code": "US",
            "postal_code": "100214823",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Kendall Black
• Kyla E Black, LCSW
• Kytra Black, LCSW
• Margaret Jean Black, LCSW
• Marita F Black, PT
• Natasha Black, PHD
• Robert Black
• Shante Black
• Suzanne Alexandra Black
• Suzanne Marie Black, NP

• Physician Assistant in New York, NY
• Providers in New York, NY by specialty
• Physician Assistant in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 1, 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.