Timonthy Donell Black

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5014067 Issued in NC

Practice address

113 Scenic Outlet LN Ste 2
Mount Airy, NC 27030-9978

Phone

(336) 352-4900

Fax

(336) 352-4901

NPI assigned

Feb 1, 2021

Sex

Male

Sole proprietor

Yes

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.

• Challie Minton MD

  • Family Medicine Physician
  • Mount Airy, NC
  • NPI 1790298024

  NC

  Medicare reassignment Care Compare group NPD
• Jefferson Emergency Services, PLLC

  • Emergency Medicine Physician
  • Jefferson, NC
  • NPI 1720495336

  NC

  Medicare reassignment Care Compare group NPD
• Lifebrite Hospital Group of Stokes, LLC

  • Pediatrics Physician
  • Danbury, NC
  • NPI 1104369081

  NC

  Medicare reassignment NPD
• Lifebrite Hospital Group of Stokes, LLC

  • Critical Access Hospital
  • Danbury, NC
  • NPI 1396288999

  NC

  Medicare reassignment NPD
• Yadkin Emergency Physicians, PLLC

  • Emergency Medicine Physician
  • Elkin, NC
  • NPI 1417443771

  NC

  Medicare reassignment NPD
• Patrick County Family Practice,PC

  • Family Medicine Physician
  • Stuart, VA
  • NPI 1053322495

  VA

  Medicare reassignment NPD
• Lifebrite Hospital Group of Stokes, LLC

  • Rural Health Clinic/Center
  • Pine Hall, NC
  • NPI 1346775285
  NPD
• Lifebrite Hospital Group of Stokes, LLC

  • Critical Access Hospital
  • Danbury, NC
  • NPI 1841733714
  NPD
• Patrick Urgent Care

  • Urgent Care Clinic/Center
  • Stuart, VA
  • NPI 1598236101
  NPD

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

• Ashe Memorial Hospital Inc

  • Critical Access Hospital
  • Jefferson, NC
  • NPI 1376671370

  Hospital

  Care Compare affiliation
• Lifebrite Hospital Group of Stokes, LLC

  • Critical Access Hospital
  • Danbury, NC
  • NPI 1396288999

  Hospital

  Care Compare affiliation
• Northern Hospital of Surry County

  • General Acute Care Hospital
  • Mount Airy, NC
  • NPI 1366449282

  Hospital

  Care Compare affiliation

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Challie Minton, MD PC 9 clinicians

Jefferson Emergency Services PLLC 21 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Lifebrite Community Hospital of Stokes Hospital, Danbury, NC, CCN 341317
• Northern Regional Hospital Hospital, Mount Airy, NC, CCN 340003
• Ashe Memorial Hospital Hospital, Jefferson, NC, CCN 341325

Medicare fee-for-service enrollment

Enrolled in VA, NC2 enrollments

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 2

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/16817/brand/1/csg/1/fhir/r4
• FHIR API: https://api.platform.athenahealth.com/14272/brand/70/csg/1/fhir/r4
• FHIR API: https://fhir.meditouchehr.com/api/fhir/r4/
• Direct secure messaging: timonthyblack@cmm-nc.direct.office.nextgen.com
• FHIR API: https://fhir-api.fhirprod.aws.greenwayhealth.com/fhir/R4/2.16.840.1.113883.3.140.61556

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on May 16, 2024.

{
    "created_epoch": "1612137600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1715817600000",
    "number": "1992396022",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1132 CARTER MOUNTAIN RD",
            "city": "STUART",
            "state": "VA",
            "postal_code": "241713769",
            "telephone_number": "336-345-6731"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "113 SCENIC OUTLET LN STE 2",
            "city": "MOUNT AIRY",
            "state": "NC",
            "postal_code": "270309978",
            "telephone_number": "336-352-4900",
            "fax_number": "336-352-4901"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1132 Carter Mountain Rd",
            "address_purpose": "LOCATION",
            "city": "Stuart",
            "state": "VA",
            "postal_code": "241713769",
            "country_code": "US",
            "telephone_number": "336-345-6731",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BLACK",
        "first_name": "TIMONTHY",
        "middle_name": "DONELL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-02-01",
        "last_updated": "2024-05-16",
        "certification_date": "2024-05-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5014067",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sean Tyler Best, PT, DPT
• Stephanie Lauren Best, PTA
• Bethany Medical Center
• Jeanette Marie Billett, M.D.
• David Allen Bishop Jr., RN
• Hannah Bledsoe, PT, DPT
• Donl F Blevins II, DNP, FNP-BC
• Shelby George Blevins III
• Blue Ridge Orthopaedics and Sports Medicine PA
• Charles R. Bokesch, M.D.

• All providers in Mount Airy, NC
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2024; 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.