BRENDAN ALEXANDER BLACK (PT, DPT) – Physical Therapist, NPI 1104409143

BRENDAN ALEXANDER BLACK (PT, DPT) is a healthcare provider. based in Lees summit, Missouri. specializing in PHYSICAL THERAPIST IN PRIVATE PRACTICE. They hold the professional credentials PT, DPT. They hold a License No. 2021023467 (MO). The NPI Number for BRENDAN ALEXANDER BLACK (PT, DPT) is 1104409143

Main info

Male
5 Years Of Experience
Accepts Medicare Assignment
Name
BRENDAN ALEXANDER BLACK (PT, DPT)
NPI
1104409143
Phone
(816) 607-7180
Address
1321 SW MARKET ST
Enumeration Date
28 April 2021
Last Update Date
5 April 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8166077180
Graduation Year
2021 (5 years ago)
PAC ID
6608279864
Group Practice PAC ID
1153582416
Professional Enrollment ID
I20210726001526
Address ID
MO640812904LE1321XSTXX400
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience34
Completeness75
Years active:5State licenses:1Digital endpointsOther names

1,533 PHYSICAL THERAPIST IN PRIVATE PRACTICE in MO

Provider Addresses for BRENDAN ALEXANDER BLACK (PT, DPT)

  • 1321 SW MARKET ST

    LEES SUMMIT, MO 640812904

    Phone: (816) 607-7180

    Type: Mailing

  • 1200 CORPORATE DR STE 400

    HOOVER, AL 352425424

    Phone: (423) 238-7217

    Type: Mailing

  • 540 E YOUNG AVE STE E

    WARRENSBURG, MO 640931250

    Phone: (660) 262-4795

    Fax: (660) 747-0347

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2021-07-26

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20210726001526IPhysical Therapist In Private PracticeMOTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

Top Medicare procedures (2023) · refreshed 2026-05-27

HCPCSDescriptionServicesBeneficiariesMedicare allowed
97530Therapy procedure using functional activities82588$0
97112Therapy procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes75489$0
97110Therapy procedure using exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes73887$0
97140Therapy procedure using manual technique, each 15 minutes21944$0
97150Therapy procedure in a group setting11735$0
View full utilization report →

Insurance plans in this area (ZIP 64081)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1153582416View full group profile
NameSpecialtyState
Physical Therapist In Private PracticeMO
Physical Therapist In Private PracticeMO
Physical Therapist In Private PracticeGA
Physical Therapist In Private PracticeKS
Physical Therapist In Private PracticeKS
-KS
Physical Therapist In Private PracticeMO
-NY
Physical Therapist In Private PracticeKS

Reviews

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Frequently asked questions

Can I verify BRENDAN ALEXANDER BLACK (PT, DPT) with an NPI only?
You can start verification with NPI 1104409143 for BRENDAN ALEXANDER BLACK (PT, DPT), then check state licensing separately.
Is BRENDAN ALEXANDER BLACK (PT, DPT) still practicing?
BRENDAN ALEXANDER BLACK (PT, DPT) is currently listed as active in the public NPI registry.
What is BRENDAN ALEXANDER BLACK (PT, DPT)'s primary classification?
Physical Therapist is the headline specialty for BRENDAN ALEXANDER BLACK (PT, DPT) here. Clinical services aligned with this taxonomy classification.
Where is BRENDAN ALEXANDER BLACK (PT, DPT) based?
BRENDAN ALEXANDER BLACK (PT, DPT) is tied to Lees Summit, Missouri in the data we show; additional addresses may exist on the full record.
Is the information about BRENDAN ALEXANDER BLACK (PT, DPT) up to date?
Data updates when providers file changes in NPPES — treat critical facts as "verify if unsure."

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