Michael Lane Black, M.D.
Individual provider Active NPI Family Medicine Physician · Poland, OH
NPI 1497730857 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1497730857
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 35069367 (OH)
- Practice address
- 6615 Clingan Road
Suite a
Poland, OH 44514-4202 - Phone
- (330) 707-1425
- Fax
- (330) 757-2814
- NPI assigned
- Dec 8, 2005
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 5
Hospital & facility affiliations 9
Medicare Care Compare profile
- Specialty
- Family Practice
- Education
- Ohio State University College of Medicine, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Poland Medical Center LTD
Practice addresses (Care Compare)
6615 Clingan Rd
Suite a
Poland, OH 44514-2196
Phone (330) 757-7211
Hospital & facility affiliations
- Akeso Home Health Care Inc
- Patriot Homecare, Inc
- Mercy Health Home Care -Youngstown
- Akeso Home Hospice Inc
- HMHP St Elizabeth Boardman Health Center
- MH St Elizabeth Youngstown Hospital
- Surgical Hospital at Southwoods
- Masternick Memorial Health Care Center
Merit-based Incentive Payment System (MIPS)
- Final score
- 82.47 of 100
- Quality
- 73.84
- Improvement activities
- 40
- Cost
- 76.44
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in OH
- 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 |
|---|---|---|---|---|
| I20061205000081 | OH | Practitioner - Family Practice | 6305845280 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 35069367 | OH | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Poland Medical Center LTD | Family Medicine | Current |
Accepting new patients |
| Omni Manor, Inc. | Past | Accepting new patients | |
| Foundation Health Care, Inc | Family Medicine | Past |
Accepting new patients |
| Lima Memorial Joint Operating Company | Past | Accepting new patients | |
| Comprehensive Behavioral Health Associates, Inc. | Past | Accepting new patients |
Locations
6615 Clingan Rd
Ste A
Youngstown, OH 44514
Phone (330) 707-1425
6615 Clingan Rd
Ste C
Youngstown, OH 44514
Phone (330) 757-7888
Interoperability endpoints
- mblack@polandmedical.medentdirect.com
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 35069367 | OH | Yes |
Addresses
Primary practice location
6615 Clingan Road
Suite a
Poland, OH 44514-4202
Mailing address
6615 Clingan Road
Suite a
Poland, OH 44514-4202
Phone (330) 707-1425
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 35069367 | Other | OH | LICENSE |
| 2104752 | Medicaid | OH |
Other providers in Poland, OH
- David Anthony Belvedere
- Bethann Passarello Inc
- Carla Louise Bettross
- Bilas Physical Therapy, Inc.
- Dennis John Bilas
- Gregory Blasko
- Jill Blinsky
- Alexa Nicole Bodine
- Marie Josephine Bosio
- Jacob Anthony Bova
All providers in Poland, OH · Family Medicine Physician in Ohio
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 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.