Active NPI
William J Black, MD
- Emergency Medicine Physician
- Harriman, TN
National Provider Identifier
1720019284
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Emergency Medicine Physician
- License
- 015791
- Practice address
- 412 Devonia St
Harriman, TN 37748-2009 - Phone
- (865) 882-1323
- Fax
- (865) 291-3228
- NPI assigned
- Jul 5, 2006
- Last updated
- Nov 16, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician | 207P00000X | 015791 | TN | Primary |
Addresses
Primary practice location
412 Devonia St
Harriman, TN 37748-2009
Mailing address
PO Box 636019
Cincinnati, OH 45263-6019
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3331539 | Medicaid | TN | |
| 4105155 | Other | TN | BCBS OF TENNESSEE |
| P00282933 | Other | TN | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 015791 | TN | MD | Emergency Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Emergency Coverage, LLC | Emergency Medicine | Past | Accepting new patients |
| Abercrombie Radiological Consultants Inc | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Diagnostic Radiology Physician
- Knoxville, TN
- NPI 1942207154
-
dba Emergency Coverage Corporation of TeamHealth
- Family Medicine Physician
- Newport, TN
- NPI 1427005008
Emergency Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152057600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1195171200000",
"number": "1720019284",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 636019",
"city": "CINCINNATI",
"state": "OH",
"postal_code": "452636019"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "412 DEVONIA ST",
"city": "HARRIMAN",
"state": "TN",
"postal_code": "377482009",
"telephone_number": "865-882-1323",
"fax_number": "865-291-3228"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BLACK",
"first_name": "WILLIAM",
"middle_name": "J",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-05",
"last_updated": "2007-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "207P00000X",
"taxonomy_group": "",
"desc": "Emergency Medicine",
"state": "TN",
"license": "015791",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3331539",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS OF TENNESSEE",
"identifier": "4105155",
"state": "TN"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00282933",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Harriman, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.