Timothy R. Black, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA772 Issued in TN

Practice address

10800 Parkside Dr Ste 330
Knoxville, TN 37934-1926

Phone

(865) 218-7480

Fax

(865) 218-7488

NPI assigned

Jul 28, 2006

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 TN

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

Merit-based Incentive Payment System (MIPS)

Final score

88.07 of 100Reported as apm

Quality

73.89

Promoting interoperability

100

Improvement activities

40

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Emergency Coverage Services, PC

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  • Lawrenceburg, TN
  • NPI 1053351593
  Medicare reassignment
• Knoxville Hma Physician Management, LLC

  • Pulmonary Disease Physician
  • Knoxville, TN
  • NPI 1629356969
  Medicare reassignment
• Southeastern Emergency Services P C

  • Nurse Practitioner
  • Athens, TN
  • NPI 1669414264
  Medicare reassignment
• Southeastern Emergency Physicians LLC

  • Emergency Medicine Physician
  • Maysville, KY
  • NPI 1356379382

  TN

  Medicare reassignment

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

{
    "created_epoch": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690243200000",
    "number": "1720092307",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10800 PARKSIDE DR STE 330",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379341926",
            "telephone_number": "865-218-7480",
            "fax_number": "865-218-7488"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10800 PARKSIDE DR STE 330",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379341926",
            "telephone_number": "865-218-7480",
            "fax_number": "865-218-7488"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "TIMOTHY",
        "middle_name": "R.",
        "name_prefix": "Mr.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2023-07-25",
        "certification_date": "2023-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TN",
            "license": "PA772",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Makenna Black
• Michelle Black, PH.D.
• Monica Lee Black, M.D.
• Olivia Black, OTR/L
• Sarah Black, PA-C
• Tyler Black
• William D Black, MD
• Van Tyler Blackaby, PMHNP-BC
• Blackbird Nutrition Therapy
• Bethany Wilma Wright Blackburn, MD

• Physician Assistant in Knoxville, TN
• Providers in Knoxville, TN by specialty
• Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2023; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.