NPIMap

Individual provider Active NPI

Michael Jason Black, M.D.

  • Surgery Physician
  • Appleton, WI
National Provider Identifier
1720036387
Registry record updated Jul 22, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Surgery PhysicianTaxonomy code 208600000X
License
46688-020 Issued in WI
Practice address
2000 E Milestone Dr
Appleton, WI 54913-6701
Phone
(920) 731-8131
Fax
(920) 832-0444
NPI assigned
May 5, 2006
Last updated
Jul 22, 2025By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2025

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X 46688 WI
Surgery Physician 208600000X 46688-020 WI Primary

Addresses

Primary practice location

2000 E Milestone Dr
Appleton, WI 54913-6701

Mailing address

2000 E Milestone Dr
Appleton, WI 54913-6701
Phone (920) 731-8131

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WI
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
I20081010000327 WI Practitioner - General SurgeryPractitioner - Colorectal Surgery (Proctology) 9931293958 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
General SurgeryAlso: Colorectal Surgery (Proctology)
Education
Medical College of Wisconsin, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Fox Valley Surgical Associates LTDGroup PAC ID 7911971296, 35 clinicians

Practice addresses (Care Compare)

2000 E Milestone Dr
Appleton, WI 54913-6701
Phone (920) 731-8131

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Colonoscopy63
Hernia repair - groin (open)1-10
Hernia repair (minimally invasive)1-10
Upper gastrointestinal (GI) endoscopy for acid reflux46
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
46688WIMDSurgery Physician
46688-020WIMDSurgery Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Fox Valley Surgical Associates LTD Surgery CurrentSince Sep 1, 2008 Accepting new patients
Fox Valley Surgical Associates LTD Current Accepting new patients
Fox Valley Pulmonary Medicine, S.C. Past Accepting new patients

Locations

1818 N Meade St
#240W
Appleton, WI 54911
Phone (920) 731-4101

1818 N Meade St
Ste 240
Appleton, WI 54911
Phone (920) 731-8289

2000 E Milestone Dr
Appleton, WI 54913
Phone (920) 358-1729

2500 E Capitol Dr
Ste 1700
Appleton, WI 54911
Phone (920) 734-9600

Interoperability endpoints

  • Direct secure messaging: mblack18456@direct.thedacare.org

Organizations & group practices 3

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 12

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": "1146787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1753142400000",
    "number": "1720036387",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2000 E MILESTONE DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549136701",
            "telephone_number": "920-731-8131",
            "fax_number": "920-832-0444"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2000 E MILESTONE DR",
            "city": "APPLETON",
            "state": "WI",
            "postal_code": "549136701",
            "telephone_number": "920-731-8131",
            "fax_number": "920-832-0444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "MICHAEL",
        "middle_name": "JASON",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-05-05",
        "last_updated": "2025-07-22",
        "certification_date": "2025-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "46688",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "46688-020",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Appleton, WI

Sources for this page

Verify at the official NPI Registry.