Thomas Black, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

02922 Issued in NM

Practice address

104 Quail Trail
Unit B
Edgewood, NM 87015

Phone

(505) 208-0208

Fax

(505) 717-2884

NPI assigned

Sep 23, 2015

Last updated

Jul 26, 2021By 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 TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

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.

• DHHS PHS Naihs Crownpoint Hospital

  • General Acute Care Hospital
  • Crownpoint, NM
  • NPI 1114960093

  TX

  Medicare reassignment NPD
• Pueblo Pintado Clinic

  • Clinic/Center
  • Cuba, NM
  • NPI 1023051133
  NPD
• Thoreau Clinic

  • Clinic/Center
  • Thoreau, NM
  • NPI 1679516702
  NPD
• Southeast Iowa Regional Medical Center, Inc.

  dba Southeast Iowa Regional Medical Center

  • General Practice Physician
  • West Burlington, IA
  • NPI 1164433884
  NPD (past)

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

{
    "created_epoch": "1442966400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627257600000",
    "number": "1619346376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 QUAIL TRAIL",
            "address_2": "UNIT B",
            "city": "EDGEWOOD",
            "state": "NM",
            "postal_code": "87015",
            "telephone_number": "505-208-0204",
            "fax_number": "505-717-2884"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 QUAIL TRAIL",
            "address_2": "UNIT B",
            "city": "EDGEWOOD",
            "state": "NM",
            "postal_code": "87015",
            "telephone_number": "505-208-0208",
            "fax_number": "505-717-2884"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "THOMAS",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2015-09-23",
        "last_updated": "2021-07-26",
        "certification_date": "2021-07-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NM",
            "license": "02922",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• At Home Geriatric Counseling and Consultation
• Cynthia Batie, RPH
• Faith Beck, M.A, L.P.C.C.
• Elizabeth Bennett
• Liza Black
• Eva Mae Blakely, MS/CCC-SLP
• Krystal Marie Blanton
• Monica Briones, M.D.
• Louis R Bush, DDS
• Sharon Carpenter, RPH

• Family Nurse Practitioner in Edgewood, NM
• Providers in Edgewood, NM by specialty
• Family Nurse Practitioner in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 2021; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.