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

Last updated

May 16, 2024By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

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

Specialty

Nurse Practitioner

Education

Other, 2021

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Challie Minton, MD PCGroup PAC ID 5597180802, 9 clinicians

Jefferson Emergency Services PLLCGroup PAC ID 4880813047, 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 enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

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

• Challie Minton MD

  • Family Medicine Physician
  • Mount Airy, NC
  • NPI 1790298024
  Medicare reassignment Care Compare group NPD
• Jefferson Emergency Services, PLLC

  • Emergency Medicine Physician
  • Jefferson, NC
  • NPI 1720495336
  Medicare reassignment Care Compare group NPD
• Lifebrite Hospital Group of Stokes, LLC

  dba LifeBrite Pediatric Clinic of Danbury

  • Pediatrics Physician
  • Danbury, NC
  • NPI 1104369081
  Medicare reassignment NPD
• Lifebrite Hospital Group of Stokes, LLC

  dba LifeBrite Community Hospital of Stokes

  • Critical Access Hospital
  • Danbury, NC
  • NPI 1396288999
  Medicare reassignment NPD
• Yadkin Emergency Physicians, PLLC

  • Emergency Medicine Physician
  • Elkin, NC
  • NPI 1417443771
  Medicare reassignment NPD
• Patrick County Family Practice,PC

  • Family Medicine Physician
  • Stuart, VA
  • NPI 1053322495
  Medicare reassignment NPD
• Lifebrite Hospital Group of Stokes, LLC

  dba LifeBrite Family Medical & Urgent Care of Pine Hall

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

  dba LifeBrite Community Hospital of Stokes

  • 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
  Care Compare affiliation
• Lifebrite Hospital Group of Stokes, LLC

  dba LifeBrite Community Hospital of Stokes

  • Critical Access Hospital
  • Danbury, NC
  • NPI 1396288999
  Care Compare affiliation
• Northern Hospital of Surry County

  dba North Hospital of Surry County

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

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

{
    "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": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5014067",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "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.

• Family Nurse Practitioner in Mount Airy, NC
• Providers in Mount Airy, NC by specialty
• 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.