Theresa Ann Black, FNP-BC

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

49062 Issued in WV

Practice address

11 N Locust St
Buckhannon, WV 26201-4707

Phone

(304) 472-1600

NPI assigned

Jun 29, 2007

Last updated

Nov 29, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Theresa Ann Black Other name

Medicare fee-for-service enrollment

Enrolled in WV

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

Specialty

Nurse Practitioner

Education

Other, 2007

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Davis Memorial HospitalGroup PAC ID 3072418540, 77 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Davis Medical Center Hospital, Elkins, WV, CCN 510030
• St Joseph's Hospital of Buckhannon, Inc Hospital, Buckhannon, WV, CCN 511321

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: theresa.poling.p1@direct.davismedicalcenter.nextgenshare.com

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.

• Davis Memorial Hospital

  dba Davis Medical Center

  • General Acute Care Hospital
  • Elkins, WV
  • NPI 1619964806
  Medicare reassignment Care Compare group NPD
• Davis Memorial Hospital

  dba Health Center Pharmacy

  • Community/Retail Pharmacy
  • Elkins, WV
  • NPI 1700663226
  NPD

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

• Davis Memorial Hospital

  dba Davis Medical Center

  • General Acute Care Hospital
  • Elkins, WV
  • NPI 1619964806
  Care Compare affiliation
• St Josephs Hospital of Buckhannon Inc

  • Critical Access Hospital
  • Buckhannon, WV
  • NPI 1124005061
  Care Compare affiliation

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

{
    "created_epoch": "1183075200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701216000000",
    "number": "1790982080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "812 GORMAN AVENUE",
            "city": "ELKINS",
            "state": "WV",
            "postal_code": "26241",
            "telephone_number": "304-637-3456",
            "fax_number": "304-637-3441"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11 N LOCUST ST",
            "city": "BUCKHANNON",
            "state": "WV",
            "postal_code": "262014707",
            "telephone_number": "304-472-1600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLACK",
        "first_name": "THERESA",
        "middle_name": "ANN",
        "name_prefix": "Ms.",
        "credential": "FNP-BC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-06-29",
        "last_updated": "2023-11-29",
        "certification_date": "2023-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "WV",
            "license": "49062",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "WV",
            "license": "49062",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3810009382",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "THERESA",
            "last_name": "BLACK",
            "middle_name": "ANN",
            "credential": "FNP-BC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Linda Sue Biller
• Bio-Medical Applications of West Virginia, Inc. (Fresenius Medical Care Upshur County)
• Mary Bishop
• Angela Marie Black
• Joyce Black
• Bonnie Lynn Blackburn, PA
• Amber R. Blackledge, PA-C
• Mary Blake
• Sandra Blake
• Karen Sue Bland

• Family Nurse Practitioner in Buckhannon, WV
• Providers in Buckhannon, WV by specialty
• Family Nurse Practitioner in West Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 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.