NPIMap

Individual provider Active NPI

Michael Lane Black, M.D.

  • Family Medicine Physician
  • Poland, OH
National Provider Identifier
1497730857
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
35069367 Issued in 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
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Medicine Physician 207Q00000X 35069367 OH Primary

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

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20061205000081 OH Practitioner - Family Practice 6305845280 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
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 LTDGroup PAC ID 3678572559, 10 clinicians

Practice addresses (Care Compare)

6615 Clingan Rd
Suite a
Poland, OH 44514-2196
Phone (330) 757-7211

Hospital & facility affiliations

Merit-based Incentive Payment System (MIPS)

Final score
82.47 of 100Reported as group
Quality
73.84
Improvement activities
40
Cost
76.44

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

Practice roles

OrganizationSpecialtyStatusNew patients
Poland Medical Center LTD Family Medicine CurrentSince Dec 10, 2006 Accepting new patients
Comprehensive Behavioral Health Associates, Inc. Past Accepting new patients
Foundation Health Care, Inc Family Medicine PastSince Jan 1, 2007 Accepting new patients
Lima Memorial Joint Operating Company Past Accepting new patients
Omni Manor, 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

  • Direct secure messaging: mblack@polandmedical.medentdirect.com

Organizations & group practices 5

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.

Hospital & facility affiliations 9

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

NPI Registry JSON

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

{
    "created_epoch": "1134000000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1497730857",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6615 CLINGAN ROAD",
            "address_2": "SUITE A",
            "city": "POLAND",
            "state": "OH",
            "postal_code": "445144202",
            "telephone_number": "330-707-1425",
            "fax_number": "330-757-2814"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6615 CLINGAN ROAD",
            "address_2": "SUITE A",
            "city": "POLAND",
            "state": "OH",
            "postal_code": "445144202",
            "telephone_number": "330-707-1425",
            "fax_number": "330-757-2814"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "MICHAEL",
        "middle_name": "LANE",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-12-08",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "OH",
            "license": "35069367",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Poland, OH

Sources for this page

Verify at the official NPI Registry.